Plastic Surgery Research Council
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OUTCOMES IN CRANIOPLASTY - RISK FACTORS AND CHOICE OF RECONSTRUCTIVE MATERIAL
Presenter: Sashank K Reddy, MD, PhD
Co-Authors: Khalifian S; Flores J; Bellamy J; Borsuk D; Manson PN; Rodriguez E; Dorafshar AH
Johns Hopkins University

BACKGROUND: Continuing advances in cranioplasty have enabled repair of increasingly complicated cranial defects. However, the optimal materials and approaches for particular clinical scenarios remain unclear. This study examines outcomes following cranioplasty for a variety of indications in patients treated with alloplastic material, autogenous tissue, or a combination of both.?

METHODS: A retrospective analysis was conducted on 180 patients who had 195 cranioplasties performed at the Johns Hopkins Hospital between 1993 and 2010. Outcomes studied include infection, wound dehiscence, exposure or resorption of cranioplasty material, flap loss, CSF leak, fluid collection, and death. Requirement for reoperation was also noted. Statistical analysis utilized univariate and multivariate logistic regression and analysis of covariance.?

RESULTS: Cranioplasty materials included alloplastic 42.6% (83/195), autologous 19.0% (37/195), and both combined 38.5% (75/195). Mean defect size was 70.5 cm2. A subset of patients had undergone previous irradiation 12.2% (22/180) or had infections 30.6% (55/180) prior to their procedure. The most common complication was postoperative infection 15.9% (31/195). Factors that significantly predisposed to complications included preoperative radiation, previous infection, and frontal location. Preoperative radiation was the strongest predictor of whether patients would develop any complication with an odds ratio (OR) of 7.58 (p < 0.001). These patients were more likely to require repeat operations than their non-irradiated counterparts (OR 5.28, p < 0.005). Patients undergoing frontal cranioplasties were also more likely to require repeat operations (OR 2.03, p < 0.05). Preoperative infection predisposed patients to exposure of cranioplasty material (OR 4.02, p < 0.005).

CONCLUSIONS: The choice of cranioplasty material may modify the risk of developing postoperative complications, but it appears less important than the clinical history in affecting outcome. Attempts to eradicate preexisting infection and minimize exposure to radiation may limit complications in cranioplasty procedures.


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