Work

Implant-retaining management of cranioplasty-related surgical infections

Year: 2025

Type: article

Abstract: BACKGROUND: Surgical-site infections (SSIs) are the most common cause of failure in cranial repair surgeries. Most cranioplasty-related infections result in implant removal, recreating a problematic cranial bone defect. Implant-retaining cranioplasty infection management has gained clinical interest following initial success in small patient cohorts. We audited the results of implant-retaining cranioplasty infection management at Cambridge University Hospital. METHODS: We retrospectively identified 206 cranioplasty procedures conducted in 195 patients between November 2017 and December 2021 and systematically assessed cranioplasty-related SSI management and outcomes. RESULTS: In total, 201 (98%) cranioplasties were performed with titanium implants. Sixty-seven patients (33%) had one or more complications. SSIs occurred after 34 (17%) cranioplasties. Twenty (10%) cranioplasties were removed because of infections, and in total, 25 (12%) cranioplasties were removed due to complications. Implant-retaining SSI management was attempted in 23 cases, and it was successful in 14 of 23 (61%). Wound discharge was associated with failure of implant-retaining infection management (P<0.003), but wound dehiscence, microbiological culture results, timing of the infection, previous infection of the cranioplasty site, inflammatory parameters, collections in imaging, age, clinical condition and shunt treatment were not. CONCLUSIONS: With appropriate patient selection, implant-retaining management of cranioplasty infections appears to produce viable long-term results. This approach may be considered in reasonably healthy patients whose neurological status can be monitored. These results have influenced our clinical decision-making, and we now aim to retain cranioplasty implants in all patients presenting with suspected SSI with intact or non-discharging wounds who are not systemically unwell. Prospective studies are needed to confirm our results.

Source: Journal of Hospital Infection

DOI: 10.1016/j.jhin.2025.04.040