====== Cranioplasty infection prevention ====== {{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1JmYa8PH-W6QcrqFROmtzrtP6aMEIQ_WNSHStvty8bJ1cpCo6n/?limit=15&utm_campaign=pubmed-2&fc=20230115152707}} ---- ---- Thorough knowledge and understanding of [[cranioplasty infection risk factors]] may lead to surgical strategies and bundles, aiming to reduce infectious complications of cranioplasty. Finally, innovation in materials used for cranial repair should also aim to enhance the antimicrobial properties of these inert materials ((Frassanito P, Fraschetti F, Bianchi F, Giovannenze F, Caldarelli M, Scoppettuolo G. Management and prevention of cranioplasty infections. Childs Nerv Syst. 2019 Sep;35(9):1499-1506. doi: 10.1007/s00381-019-04251-8. Epub 2019 Jun 20. PMID: 31222447.)). ---- Cranioplasty carried out at a minimum of 6 months post-craniectomy limits the risk of infection ((Thavarajah D, De Lacy P, Hussien A, Sugar A. The minimum time for cranioplasty insertion from craniectomy is six months to reduce risk of infection--a case series of 82 patients. Br J Neurosurg. 2012 Feb;26(1):78-80. doi: 10.3109/02688697.2011.603850. Epub 2011 Oct 5. PubMed PMID: 21973063. )). In the setting of recurrent infection and multiple failed reconstruction attempts, the choice of the ideal reconstructive material for salvage cranioplasty remains a source of controversy in the literature. see [[antibiotic impregnated methyl methacrylate]] ====Case series==== 88 operations were documented as 'Cranioplasty'. Data collection include patient demographics, type of cranioplasty used, time lapse between decompression and cranioplasty, seniority of the operating surgeon(s), antibiotic regimen and complications. Outcomes were recorded at the three-month follow-up. The overall complication rate was 6.8%. The mean patient age was 36.2 years. 52.2% of patients had decompressive craniectomy for trauma, 11.3% had infectious pathology, 9% had subarachnoid haemorrhage, 9% had tumour with bone infiltration and 3.4% had stroke. 55.7% of patients had cranioplasty within 6 months of craniectomy. 61.3% of cranioplasties were with autologous bone, 20.4% titanium, 10.2% acrylic and 7.9% polyetheretherketone (PEEK). Significant complications included one case of infection, two cases of subgaleal haematoma and one extradural collection. No deaths were noted. No correlation was found between infection and the use of drains. 68.6% of cases were done by either a senior surgeon or a supervised registrar. There was an observable difference in complication rates in relation to the seniority and experience of the operator. However, patient numbers and complications were insufficient to achieve statistical significance. Strict antimicrobial prescribing was observed ((Liang ES, Tipper G, Hunt L, Gan PY. Cranioplasty outcomes and associated complications: A single-centre observational study. Br J Neurosurg. 2015 Sep 2:1-6. [Epub ahead of print] PubMed PMID: 26328774.)). ===2013=== A total of 85 patients underwent reconstructive cranioplasty after decompressive craniectomy between January 2009 and July 2011 and had a follow-up period of > 1 year; charts were reviewed retrospectively. Although autograft was used whenever possible, artificial bone was used for cranioplasty. GIC was defined as infection requiring removal of the bone graft. RESULTS: GIC occurred in six patients (7.05 %). GIC was not related to the indications for craniectomy, the interval of cranioplasty, graft material, or the size of the bone defect (p = 0.433, p = 0.206, p = 0.665, and p = 0.999, respectively). The GIC rate was significantly related to previous temporalis muscle resection, preoperative subgaleal fluid collection, operative times > 120 min, and postoperative wound disruptions (p = 0.001, p < 0.001, p = 0.035, and p = 0.016, respectively). Multiple logistic regression showed that the presence of a subgaleal fluid collection before cranioplasty significantly increased the risk of GIC (OR: 38.53; 95 % CI: 2.77-535.6; p = 0.006). CONCLUSIONS: The results of this study suggest that long operative times (> 120 min), craniectomy with temporalis muscle resection, the presence of preoperative subgaleal fluid collection, and postoperative wound disruption may be risk factors for graft infection after cranioplasty. Surgical techniques should be developed to reduce operative time and to avoid temporalis muscle resection when possible. In addition, meticulous dural closure aimed at reducing the formation of subgaleal fluid collection is important for the prevention of graft infections after cranioplasty ((Kim H, Sung SO, Kim SJ, Kim SR, Park IS, Jo KW. Analysis of the factors affecting graft infection after cranioplasty. Acta Neurochir (Wien). 2013 Nov;155(11):2171-6. doi: 10.1007/s00701-013-1877-8. Epub 2013 Sep 17. PubMed PMID: 24043415. )).