title: Polymethylmethacrylate imbedded with antibiotics cranioplasty: An infection solution for moderate and large defects reconstruction?
abstract: BACKGROUND
  In cases where autologous bone graft reconstruction is not possible (such as comminuted fractures, bone graft reabsorption, or infection) and the use of synthetic material is required, polymethylmethacrylate (PMMA) use is a safe and efficient solution. Studies comparing the incidence of postoperative complications between autologous and synthetic cranioplasty are heterogeneous, not allowing a conclusion of which is the best material for skull defects reconstruction. Current medical literature lacks prospective well-delineated studies with long-term follow-up that analyze the impact of antibiotic use in PMMA cranial reconstruction of moderate and large defects.
  
  
  METHODS
  A prospective series of patients, who underwent cranioplasty reconstruction with PMMA impregnated with antibiotic, were followed for 2 years. Authors collected data regarding demographic status, clinical conditions, surgical information, and its complications.
  
  
  RESULTS
  A total of 58 patients completed full follow-up with a mean group age of 40 years and a male predominance (77%). Major complications that required surgical management were identified in 5 patients, and 10 patients evolved with minor complications. Postoperative surgical site infection incidence was 3.2%.
  
  
  CONCLUSIONS
  The infection rate in patients submitted to PMMA flap cranioplasty impregnated with antibiotic is significantly inferior comparing to the data described in medical literature. A lower infection incidence impacts secondary endpoints such as minimizing surgical morbidity, mortality, hospitalization period, and, consequently, costs.
authors.affiliation: Department of Surgical Sciences, Post Graduation Program in Medicine, Porto Alegre Clinical Hospital, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Neurosurgery Department of Cristo Redentor Hospital, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Paulo Valdeci
authors.initials: PV
authors.lastname: Worm
authors.affiliation: Neurosurgery Department of Cristo Redentor Hospital, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Tobias Ludwig
authors.initials: TL
authors.lastname: do Nascimento
authors.affiliation: Cerebral Ischemia Laboratory, Department of Biochemistry, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil.
authors.forename: Fabricio
authors.initials: F
authors.lastname: do Couto Nicola
authors.affiliation: Cerebral Ischemia Laboratory, Department of Biochemistry, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil.
authors.forename: Eduardo Farias
authors.initials: EF
authors.lastname: Sanches
authors.affiliation: Neurosurgery Department of Cristo Redentor Hospital, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Carlos Fernando
authors.initials: CF
authors.lastname: Dos Santos Moreira
authors.affiliation: Neurosurgery Department of Cristo Redentor Hospital, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Luiz Pedro Willimann
authors.initials: LP
authors.lastname: Rogério
authors.affiliation: Neurosurgery Department of Cristo Redentor Hospital, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Marcelo Martins
authors.initials: MM
authors.lastname: Dos Reis
authors.affiliation: Neurosurgery Department of Cristo Redentor Hospital, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Finger
authors.affiliation: Department of Surgical Sciences, Post Graduation Program in Medicine, Porto Alegre Clinical Hospital, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Department of Plastic and Craniomaxillofacial Surgery, Porto Alegre Clinical Hospital, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Marcus Vinicius Martins
authors.initials: MV
authors.lastname: Collares
keywords: Cranioplast; infection; methylmethacrylate; neurosurgical procedures; postoperative complications; skull fractures