title: Cranioplasty after decompressive hemicraniectomy: underestimated surgery-associated complications?
abstract: OBJECTIVE
  Decompressive hemicraniectomy (DC) and duroplasty after malignant brain infarction or traumatic brain injury is a common surgical procedure. Usually, preserved bone flaps are being reimplanted after resolution of brain swelling. Alloplast cranioplasties are seldom directly implanted due to the risk of wound healing disorders. While numerous studies deal with DC, little is known about the encountered problems of bone flap reimplantation. Thus, aim of the study was to identify surgery-associated complications after bone flap reimplantation.
  
  
  METHODS
  We performed a retrospective chart analysis of patients that underwent DC and subsequent bone flap reimplantation between 2001 and 2011 at our institution. We registered demographic data, initial clinical diagnosis and surgery-associated complications.
  
  
  RESULTS
  We identified 136 patients that underwent DC and subsequent reimplantation. Forty-one patients (30.1%) had early or late surgery-associated complications after bone flap reimplantation. Most often, bone flap resorption and postoperative wound infections were the underlying causes (73%, n=30/41). Multivariate analysis identified age (p=0.045; OR=16.30), GOS prior to cranioplasty (p=0.03; OR=2.38) and nicotine abuse as a prognostic factor for surgery-associated complications (p=0.043; OR=4.02). Furthermore, patients with early cranioplasty had a better functional outcome than patients with late cranioplasty (p<0.05).
  
  
  CONCLUSIONS
  Almost one-third of the patients that are operated on for bone flap reimplantation after DC suffer from surgery-associated complications. Most often, wound healing disorders as well as bone flap resorption lead to a second or even third operation with the need for artificial bone implantation. These results might raise the question, if subsequent operations can be avoided, if an artificial bone is initially chosen for cranioplasty.
authors.affiliation: Department of Neurosurgery, Georg-August-University Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany. dorothee.wachter@med.uni-goettingen.de
authors.forename: Dorothee
authors.initials: D
authors.lastname: Wachter
authors.forename: Kim
authors.initials: K
authors.lastname: Reineke
authors.forename: Timo
authors.initials: T
authors.lastname: Behm
authors.forename: Veit
authors.initials: V
authors.lastname: Rohde
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements; D016025:Bone Transplantation; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy / Q000379:methods*; D003627:Data Interpretation, Statistical; D056424:Decompressive Craniectomy / Q000009:adverse effects*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D019904:Polymethyl Methacrylate; D011183:Postoperative Complications / Q000453:epidemiology* / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012886:Skull / Q000601:surgery; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate