Large Defect May Cause Infectious Complications in Cranioplasty

Abstract

OBJECTIVE: Cranioplasty is necessary to repair the cranial defect, produced either by decompressive craniectomy or removal of the contaminated depressed skull fracture. Complications are relatively common after cranioplasty, being reported up to 23.6%. We examined the incidence and risk factors of infectious complications after cranioplasty during last 6 year period. METHODS: From January 2000 to December 2005, 107 cranioplasties were performed in our institution. The infectious complications occurred in 17 cases that required the removal of the bone flap. We examined the age of the patients, causes of the skull defect, timing of the cranioplasty, the size of the defect, and kinds of the cranioplasty material. The size of the skull defect was calculated by a formula, 3.14 x long axis x short axis. The cranioplasty material was autogenous bone kept in a freezer in 74 patients, and polymethylmetacrylate in 33 patients. Statistical significance was tested using the chi-square test. RESULTS: The infection occurred in 17 patients in 107 cranioplasties (15.9%). It occurred in 2 of 29 cases of less than 75 cm2 defect (6.9%), and 6 in 54 cases of 75~125 cm2 defect (11.1%). Also, it occurred in 9 of 24 cases of more than 125 cm2 defect (37.5%). This difference was statistically significant (p<0.01). CONCLUSION: During the cranioplasty, special attention is required when the skull defect is large since the infection tends to occurr more commonly.