Partial titanium mesh explantation cured post-cranioplasty implant-associated scalp infection

Titanium mesh cranioplasty is routinely used worldwide for skull defect patients given its advantages, such as stability and biocompatibility. However, there are very few reports concerning the treatment of implant-associated scalp infection, which is one of the most common complications. The aim of the study is to retrospectively evaluate a novel operation technique for the treatment of titanium mesh-associated scalp infection post-cranioplasty, namely partial titanium mesh explantation (PTME). A retrospective study was conducted in all patients who underwent surgical treatment for implant-associated scalp infection from January 2012 to September 2016 in our hospital. In total, 17 patients were selected for study analysis among 231 patients who underwent cranioplasty. The treatment success rate of PTME was 85.7%. There was no statistically significant difference in demographics and characteristics except for follow-up length of time between the PTME group and TTME (total titanium mesh explantation) group (Non-paired Student's t-test, P=0.037). While, The PTME group exhibited a significantly reduced skull defect area post-operation compared with the TTME group (Non-paired Student's t-test, P=0.002). Moreover, post-PTME skull area also exhibited a significantly reduced skull defect area compared with the pre-cranioplasty area in the same patient (Non-paired Student's t-test, P=0.006). Compared with traditional surgical treatment of implant-associated scalp infection, PTME combined with strict debridement and antibiotic therapy can cure implant-associated scalp infection. Moreover, PTME could preserve sufficient titanium mesh for brain protection and cosmesis.