Cranioplasty Using a Mixture of Biologic and Nonbiologic Agents
Autor: | Demetri Arnaoutakis, Jason E. Cohn, Arash Bahrami, Jesse E. Smith |
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Rok vydání: | 2018 |
Předmět: |
Adult
Male Reoperation medicine.medical_treatment Postoperative radiotherapy Dentistry chemical and pharmacologic phenomena Outcome assessment Transplantation Autologous 03 medical and health sciences Postoperative Complications 0302 clinical medicine Risk Factors Outcome Assessment Health Care medicine Humans 030223 otorhinolaryngology Aged Retrospective Studies Original Investigation Aged 80 and over Biological Products Bone Transplantation business.industry Graft Survival Skull Follow up studies Prostheses and Implants Middle Aged Plastic Surgery Procedures Cranioplasty Transplantation surgical procedures operative Bone transplantation Female Surgery Graft survival business 030217 neurology & neurosurgery Follow-Up Studies |
Zdroj: | JAMA Facial Plastic Surgery. 20:9-13 |
ISSN: | 2168-6092 2168-6076 |
Popis: | A surgeon faces challenges with cranioplasty techniques to achieve a successful result with relatively few complications.To describe a unique technique for incorporating both biologic autologous bone and nonbiologic allograft materials for defect coverage in cranioplasty with favorable outcomes and low occurrence of complications.A retrospective medical records review of all 26 patients who underwent primary cranioplasty procedure with a modified technique between January 2011 and December 2015 at a high-volume head and neck oncologic reconstructive practice was conducted; data analysis was also performed during that period. After several years of experience with traditional cranioplasty maneuvers, the modified technique has evolved to incorporate both autologous bone grafts and alloplastic materials in the formation of a shapeable on-lay material. Data were collected on demographics, need for cranioplasty, materials used, outcomes, and risk factors.Rates of infection, hematoma, flap loss or resorption, cerebrospinal fluid leak, hardware exposure or malfunction, and repeated reconstruction.Of the 26 patients, 21 (81%) were men; mean (SD) age was 65.8 (14.3) years. Eight (31%) patients had a history of diabetes, 4 (15%) patients were receiving immunosuppressive drugs, and 5 (19%) patients were active smokers at the time of surgery. Neoplasia was the most common cause of the calvarial defect seen, responsible for 20 of 28 (71%) operative defects and necessitated procedures. All but 1 patient achieved successful mineralization following primary cranioplasty with the modified technique; this success was verified based on physical examination and follow-up imaging. Complications were rare and involved only 3 patients who developed postoperative infection; 1 (4%) of these patients lost the integrity of the cranioplasty. Thus, the rate of infection was 11% and loss rate was 4%. Preoperative and postoperative radiotherapy appeared to have no bearing on graft survival.The results using a unique technique for incorporating both biologic autologous bone and nonbiologic allograft materials for defect coverage in cranioplasty are favorable, with satisfactory aesthetic outcomes and limited postoperative complications.4. |
Databáze: | OpenAIRE |
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