title: Cranioplasty with custom-made titanium plates--14 years experience.
abstract: BACKGROUND
  There is no consensus on which material is best suited for repair of cranial defects.
  
  
  OBJECTIVE
  To investigate the outcomes following custom-made titanium cranioplasty.
  
  
  METHODS
  The medical records for all patients who had titanium cranioplasty at 2 major neurosurgical centers in Western Australia were retrieved and analyzed for this retrospective cohort study.
  
  
  RESULTS
  Altogether, 127 custom-made titanium cranioplasties on 113 patients were included. Two patients had 3 titanium cranioplasties and 10 patients had 2. Infected bone flap (n = 61, 54%), either from previous craniotomy or autologous cranioplasty, and contaminated bone flap (n = 16, 14%) from the initial injury were the main reasons for requiring titanium cranioplasty. Complications attributed to titanium cranioplasty were common (n = 33, 29%), with infection being the most frequent complication (n = 18 patients, 16%). Complications were, on average, associated with an extra 7 days of hospital stay (interquartile range 2-17). The use of titanium as the material for the initial cranioplasty (P = .58), the presence of skull fracture(s) (P > .99) or scalp laceration(s) (P = .32) at the original surgery, and proven local infection before titanium cranioplasty (P = .78) were not significantly associated with an increased risk of infection. Infection was significantly more common after titanium cranioplasty for large defects (hemicraniectomy [39%] and bifrontal craniectomy [28%]) than after cranioplasty for small defects (P = .04).
  
  
  CONCLUSIONS
  Complications after using titanium plate for primary or secondary cranioplasty were common (29%) and associated with an increased length of hospital stay. Infection was a major complication (16%), and this suggested that more vigorous perioperative infection prophylaxis is needed for titanium plate cranioplasty.
authors.affiliation: Department of Neurosurgery, Royal Perth Hospital, Perth, Western Australia, Australia. anwiggins77@hotmail.com
authors.forename: Anthony
authors.initials: A
authors.lastname: Wiggins
authors.forename: Richard
authors.initials: R
authors.lastname: Austerberry
authors.forename: David
authors.initials: D
authors.lastname: Morrison
authors.forename: Kwok M
authors.initials: KM
authors.lastname: Ho
authors.forename: Stephen
authors.initials: S
authors.lastname: Honeybul
mesh_terms: D001860:Bone Plates; D001927:Brain Diseases / Q000601:surgery; D056424:Decompressive Craniectomy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology; D008137:Longitudinal Studies; D008297:Male; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012307:Risk Factors; D019291:Skull Base / Q000601:surgery*; D014025:Titanium / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D014025:Titanium