title: Clinical outcomes in cranioplasty: risk factors and choice of reconstructive material.
abstract: BACKGROUND
  Continuing advances in cranioplasty have enabled repair of increasingly complicated cranial defects. However, the optimal materials and approaches for particular clinical scenarios remain unclear. This study examines outcomes following cranioplasty for a variety of indications in patients treated with alloplastic material, autogenous tissue, or a combination of both.
  a retrospective analysis on 180 patients who had 195 cranioplasties performed between 1993 and 2010.
  
  
  RESULTS
  Materials used for cranioplasty included alloplastic for 42.6 percent (83 of 195), autologous for 19.0 percent (37 of 195), and both combined for 38.5 percent (75 of 195). Mean defect size was 70.5 cm. A subset of patients had undergone previous irradiation (12.2 percent; 22 of 180) or had preoperative infections (30.6 percent; 55 of 180). The most common complication was postoperative infection (15.9 percent; 31 of 195). Factors that significantly predisposed to complications included preoperative radiation, previous infection, and frontal location. Preoperative radiation was the strongest predictor of having any postoperative complications, with an adjusted odds ratio of 6.91 (p < 0.005). Irradiated patients (OR, 7.96; p < 0.05) and patients undergoing frontal cranioplasties (OR, 2.83; p < 0.05) were more likely to require repeated operation. Preoperative infection predisposed patients to exposure of hardware in alloplastic reconstructions (OR, 3.13; p < 0.05).
  
  
  CONCLUSIONS
  Despite the evolution of cranioplasty techniques and materials, complications are not uncommon. The choice of reconstructive material may modify the risk of developing postoperative complications but appears less important than the clinical history in affecting outcome.
  
  
  METHODS
  Risk, III.
authors.affiliation: Baltimore, Md. From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital; the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health; and the Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center.
authors.forename: Sashank
authors.initials: S
authors.lastname: Reddy
authors.forename: Saami
authors.initials: S
authors.lastname: Khalifian
authors.forename: José M
authors.initials: JM
authors.lastname: Flores
authors.forename: Justin
authors.initials: J
authors.lastname: Bellamy
authors.forename: Paul N
authors.initials: PN
authors.lastname: Manson
authors.forename: Eduardo D
authors.initials: ED
authors.lastname: Rodriguez
authors.forename: Amir H
authors.initials: AH
authors.lastname: Dorafshar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019919:Prosthesis Implantation / Q000379:methods; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D012886:Skull / Q000002:abnormalities / Q000293:injuries / Q000601:surgery*; D012888:Skull Neoplasms / Q000601:surgery; D055815:Young Adult