Implant-retaining management of cranioplasty-related surgical infections
Korhonen, Tommi K; Mee, Harry; Helmy, Adel; Sule, Olajumoke; Whiting, Gemma; Kolias, Angelos; Holland, Katherine; Hutchinson, Peter; Timofeev, Ivan (2025-11-26)
Elsevier
26.11.2025
T.K. Korhonen, H. Mee, A. Helmy, O. Sule, G. Whiting, A. Kolias, K. Holland, P. Hutchinson, I. Timofeev, Implant-retaining management of cranioplasty-related surgical infections, Journal of Hospital Infection, Volume 170, 2026, Pages 152-160, ISSN 0195-6701, https://doi.org/10.1016/j.jhin.2025.04.040
https://creativecommons.org/licenses/by/4.0/
© 2025 The Authors. Published by Elsevier Ltd on behalf of The Healthcare Infection Society. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
https://creativecommons.org/licenses/by/4.0/
© 2025 The Authors. Published by Elsevier Ltd on behalf of The Healthcare Infection Society. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
https://creativecommons.org/licenses/by/4.0/
Julkaisun pysyvä osoite on
https://urn.fi/URN:NBN:fi:oulu-202603022015
https://urn.fi/URN:NBN:fi:oulu-202603022015
Tiivistelmä
Summary
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.
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.
Kokoelmat
- Avoin saatavuus [43406]
Ellei muuten mainita, aineiston lisenssi on https://creativecommons.org/licenses/by/4.0/