title: Time Interval Reduction for Delayed Implant-Based Cranioplasty Reconstruction in the Setting of Previous Bone Flap Osteomyelitis.
abstract: BACKGROUND
  Reinfections following implant-based cranioplasty, in the setting of previous bone flap osteomyelitis, are common and associated with significant morbidity. The timing of reconstruction following initial osteomyelitic bone flap removal remains controversial; most advocate for prolonged time intervals of approximately 6 to 12 months. Thus, the authors investigated their delayed cranioplasty outcomes following both early (between 90 and 179 days) and late (≥ 180 days) time intervals with custom craniofacial implants to determine whether timing affected outcomes and rates of reinfection.
  
  
  METHODS
  An institutional review board-approved retrospective cohort review of 25 consecutive cranioplasties, from 2012 to 2014, was conducted. A nonparametric bivariate analysis compared variables and complications between the two different time interval groups, defined as early cranioplasty (between 90 and 179 days) and cranioplasty (≥ 180 days).
  
  
  RESULTS
  No significant differences were found in primary and secondary outcomes in patients who underwent early versus late cranioplasty (p > 0.29). The overall reinfection rate was only 4 percent (one of 25), with the single reinfection occurring in the late group. Overall, the major complication rate was 8 percent (two of 25). Complete and subgroup analyses of specific complications yielded no significant differences between the early and late time intervals (p > 0.44).
  
  
  CONCLUSIONS
  The results suggest that early cranioplasty is a viable treatment option for patients with previous bone flap osteomyelitis and subsequent removal. As such, a reduced time interval of 3 months--with equivalent outcomes and reinfection rates--represents a promising area for future study aiming to reduce the morbidity surrounding prolonged time intervals.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Baltimore, Md.; and Rockford, Ill. From the Departments of Plastic and Reconstructive Surgery and Neurosurgery, and the Division of Infectious Disease, The Johns Hopkins University School of Medicine; and the University of Illinois College of Medicine.
authors.forename: Joseph
authors.initials: J
authors.lastname: Lopez
authors.forename: Shuting Susan
authors.initials: SS
authors.lastname: Zhong
authors.forename: Eric W
authors.initials: EW
authors.lastname: Sankey
authors.forename: Edward W
authors.initials: EW
authors.lastname: Swanson
authors.forename: Harlyn
authors.initials: H
authors.lastname: Susarla
authors.forename: Ignacio
authors.initials: I
authors.lastname: Jusue-Torres
authors.forename: Judy
authors.initials: J
authors.lastname: Huang
authors.forename: Henry
authors.initials: H
authors.lastname: Brem
authors.forename: Paul G
authors.initials: PG
authors.lastname: Auwaerter
authors.forename: Chad R
authors.initials: CR
authors.lastname: Gordon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D010019:Osteomyelitis / Q000601:surgery*; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery*; D013524:Surgical Flaps; D013997:Time Factors; D055815:Young Adult
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