title: A preliminary report on the use of antibiotic-impregnated methyl methacrylate in salvage cranioplasty.
abstract: In the setting of recurrent infection and multiple failed reconstruction attempts, the choice of the ideal reconstructive material for salvage cranioplasty remains a source of controversy in the literature. The purpose of this study is to establish the safety and utility of antibiotic-impregnated polymethyl methacrylate (PMMA) for salvage cranioplasty.A prospectively maintained database of all patients who underwent salvage cranioplasty using vancomycin and tobramycin-impregnated methyl methacrylate from January 2011 to July 2013 was reviewed. Vancomycin and tobramycin were mixed in PMMA, which was then applied to a rigidly fixed titanium mesh for reconstruction. Patients' demographics, indications, and outcomes of this technique were evaluated.Nine patients (mean age: 47 years) underwent vancomycin and tobramycin-impregnated PMMA reconstruction with a mean follow-up of 9.3 months (range 3.5-23 months). On average, these patients underwent 4 procedures (range: 1-15), which included repeat craniotomy, debridement for infection, and failed reconstructions over the course of 3.6 years (range: 7 months to 14 years) before salvage cranioplasty. All patients required salvage cranioplasty due to infection, with the most common bacteria isolated in culture being Propionibacterium acnes (n = 3), multiresistant coagulase-negative Staphylococcus (n = 3), methicillin-resistant Staphylococcus aureus (n = 2), and Enterobacter (n = 2). The average size of the craniectomy defect was 130 cm(2), and there were no incidences of postoperative infection, postoperative complications, or need for revisions.To conclude, in short-term follow-up, vancomycin and tobramycin-impregnated PMMA reconstruction appears safe and effective in salvage cranioplasty. Our early report represents a proof of concept--the true test is whether these short-term successes translate to stable long-term results.
authors.affiliation: From the *Division of Plastic Surgery and †Department of Neurosurgery, Hospital of the University of Pennsylvania, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Vivian M
authors.initials: VM
authors.lastname: Hsu
authors.forename: Youssef
authors.initials: Y
authors.lastname: Tahiri
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Wilson
authors.forename: M Sean
authors.initials: MS
authors.lastname: Grady
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D001843:Bone Cements / Q000627:therapeutic use*; D003399:Craniotomy / Q000009:adverse effects / Q000379:methods*; D004343:Drug Implants; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019904:Polymethyl Methacrylate / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000517:prevention & control*; D019651:Plastic Surgery Procedures / Q000379:methods*; D016879:Salvage Therapy / Q000379:methods*; D014031:Tobramycin / Q000627:therapeutic use*; D014640:Vancomycin / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; D004343:Drug Implants; D014640:Vancomycin; D019904:Polymethyl Methacrylate; D014031:Tobramycin