Cosmetic Outcome of Cranioplasty After Decompressive Craniectomy—An Overlooked Aspect
| Autor: | Mohammed Nadeem, Dhaval Shukla, Diptiranjan Satapathy, Bhagavatula Indira Devi, A R Prabhuraj |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Decompressive Craniectomy Bone flap medicine.medical_specialty Adolescent Esthetics medicine.medical_treatment Outcome (game theory) Young Adult 03 medical and health sciences 0302 clinical medicine medicine Humans Child Retrospective Studies Fixation (histology) Univariate analysis business.industry Trauma center Middle Aged Plastic Surgery Procedures medicine.disease Cranioplasty Surgery Venous thrombosis Brain Injuries 030220 oncology & carcinogenesis Female Decompressive craniectomy Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | World Neurosurgery. 129:e81-e86 |
| ISSN: | 1878-8750 |
| Popis: | Background Cranioplasty (CP) is an obligatory surgery after decompressive craniectomy (DC). The primary objective is to protect the brain from external injury and prevent syndrome of trephined. In a government hospital, such cases pose a significant burden to a trauma center. Because of this reason, cosmetic outcome is never taken into account for the CP. We present results of CP performed at our hospital. Methods This is a retrospective review of the cases of CP performed over the past 3 years at our hospital. The cosmetic outcome was divided into 3 grades: 1—good symmetrical, 2—irregularities, 2a—elevated and 2b depressed, and 3—bad cosmetic outcome requiring reoperation. Results A total of 133 patients with acute brain injury underwent CP during the study period. The outcome was good in 74 (55.6%) and bad, requiring reoperation, in 2 (1.5%) cases. Various types of the CP materials like autologous bone flap, titanium mesh, and customized titanium plates were used. Methods of fixation were threads or miniplates and screws. In univariate analysis, cerebral venous thrombosis as an indication for DC, use of autologous bone flap, and fixation with thread were associated with poor outcome. However, in multivariate analysis only the method of implant fixation was associated with poor outcome. It was found that if screws and plates are used for fixation of bone flap, the chances of bad outcome are reduced by 74.6%. Conclusions The cosmetic outcome is overlooked for CP. The bone flap fixation has to be rigid for a good outcome. |
| Databáze: | OpenAIRE |
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