title: Analysis of the factors affecting outcome after combat-related cranial defect reconstruction.
abstract: BACKGROUND
  Reports on the outcomes of cranioplasty after combat-related injuries are relatively rare in the current literature. We present our results on the reconstruction of cranial defects resulting from injuries sustained in combat, comparing outcomes using autologous (iliac bone) grafts or (acrylate) allografts, and analysis of other factors that may influence the final outcome.
  
  
  METHODS
  The study comprised 207 patients with cranial defects resulting from combat-related injuries, repaired with autografts or allografts. The final outcome was defined at least 5 years postoperatively on the basis of cosmetic restoration and the existence of complications as successful (acceptable cosmetic restoration + absence of complications) or unsuccessful (poor cosmetic restoration or acceptable cosmetic restoration + complications).
  
  
  RESULTS
  Successful outcomes were achieved in 83.6% of patients; there was no operative mortality. There were 25 instances of complications: postoperative infection (n = 15, allograft (7/53), autograft (8/154)), autograft resorption (n = 8), and in two cases, graft luxation. Poor cosmetic restoration was noted in 9 (4.3%) patients who had received an autograft.
  
  
  CONCLUSIONS
  Thin and poorly vascularized skin, a surface area of the defect larger than 88 cm2, previous local infection and communication with paranasal cavities significantly influenced outcomes after combat-related cranioplasty, the final three being independent predictors of an unsuccessful outcome.
authors.affiliation: Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia. Electronic address: drpavlicevic@gmail.com.
authors.forename: Goran
authors.initials: G
authors.lastname: Pavlićević
authors.affiliation: Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Milan
authors.initials: M
authors.lastname: Lepić
authors.affiliation: Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia.
authors.forename: Predrag
authors.initials: P
authors.lastname: Perić
authors.affiliation: Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia.
authors.forename: Dražen
authors.initials: D
authors.lastname: Ivetić
authors.affiliation: Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia.
authors.forename: Ana
authors.initials: A
authors.lastname: Roganović
authors.affiliation: Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Roganović
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts / Q000601:surgery; D064592:Autografts / Q000601:surgery; D016025:Bone Transplantation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D008887:Military Medicine / Q000379:methods; D011182:Postoperative Care; D019651:Plastic Surgery Procedures / Q000379:methods; D012886:Skull / Q000293:injuries* / Q000601:surgery; D016896:Treatment Outcome; D014857:Warfare; D055815:Young Adult
keywords: Cranioplasty; Firearm injury; Head trauma; Outcome; War surgery