Plastic Surgery Research Council

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Adult Cranioplasty Outcomes with PEEK vs. Titanium: A Single Institution's Experience in 69 Patients
Malke Asaad, MD, Joseph Banuelos, MD, Amjed Abu-ghname, MD, Trishul Kapoor, MD, Uldis Bite, MD, Samir Mardini, MD, Jamie J. Van Gompel, MD, Giuseppe Lanzino, MD, Basel Sharaf, MD, DDS.
Mayo Clinic, Rochester, MN, USA.

Purpose: To compare surgical outcomes of adult cranioplasty for large cranial defects using Titanium (Ti) and PEEK implants.
Methods: A retrospective review of all adult patients who underwent alloplastic cranioplasty at our institution from 2010 to 2017 was conducted. Patients were included if: 1) they were older than 18 years old, 2) had a minimum of 1 year follow-up, and 3) had a minimum of 25 cm2 cranial defect size.
Results: A total of 69 patients met our inclusion criteria. Patients' mean age was 50 years old and average follow-up was 40 months. Ti and PEEK were used in 45 (65%) and 24 (35%) patients, respectively. Mean defect sizes were 100 cm2 in the PEEK group and 73 cm2 in the Ti group. Most common defect etiology was tumor resections (48%) followed by bone flap infection (33%). While overall complication rates were higher in the Ti (22%) group compared to PEEK (16.7%), PEEK implants demonstrated higher failure rates (16.7% vs 11%; p=0.514). Salvage rates for infected implants were 50% in both groups. History of radiation prior to reconstruction was associated with higher infections in the Ti group compared to PEEK (p=0.014).
Conclusion: PEEK implants and Titanium mesh demonstrated comparable outcomes when reconstructing large cranial defects. Patients with prior radiotherapy demonstrated increased infection rates when Ti mesh was used compared to PEEK implants. A multi-center prospective study is necessary to evaluate outcomes of these materials in various defect sizes.


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