Di Rienzo A, Colasanti R, Dobran M, Formica F, Della Costanza M, Carrassi E, Aiudi D, Iacoangeli M. Management of infected hydroxyapatite cranioplasty: Is salvage feasible?
BRAIN AND SPINE 2022;
2:100907. [PMID:
36248178 PMCID:
PMC9560697 DOI:
10.1016/j.bas.2022.100907]
[Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/13/2022] [Accepted: 06/19/2022] [Indexed: 11/30/2022]
Abstract
Introduction
The use of hydroxyapatite cranioplasties has grown progressively over the past few decades. The peculiar biological properties of this material make it particularly suitable for patients with decompressive craniectomy where bone reintegration is a primary objective. However, hydroxyapatite infection rates are similar to those of other reconstructive materials.
Research question
We investigated if infected hydroxyapatite implants could be saved or not.
Materials and methods
We present a consecutive series over a 10-year period of nine patients treated for hydroxyapatite cranioplasty infection. Clinical and radiological data from admission and follow-up, photo and video material documenting the different phases of infection assessment and treatment, and final outcomes were retrospectively reviewed in an attempt to identify the best options and possible pitfalls in a case-by-case decision-making process.
Results
Five unilateral and four bifrontal implants became infected. Wound rupture with cranioplasty exposure was the most common presentation. At revision, all implants were ossified, requiring a new craniotomy to clean the purulent epidural collections. The cranioplasty was fully saved in one hemispheric and 2 bifrontal implants and partially saved in the remaining 2 bifrontal implants. A complete cranioplasty removal was needed in the other 4 cases, but immediate cranial reconstruction was possible in 2. Skin defects were covered by free flaps in 3 cases. Four patients underwent adjunctive hyperbaric therapy, which was effective in one case.
Discussion and conclusion
In our experience, infected hydroxyapatite cranioplasty management is complex and requires a multidisciplinary approach. Salvage of a hydroxyapatite implant is possible under specific circumstances.
We present a series of 9 patients treated for hydroxyapatite cranioplasty infection.
One hemispheric and 2 bifrontal implants were fully saved, 2 bifrontal only partially.
A complete removal was needed in 4 cases, but immediate cranial reconstruction was possible in 2.
Infected hydroxyapatite cranioplasties salvage is complex, but possible under specific circumstances.
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