Cranial Reconstruction Using Antibiotic-Impregnated Calcium Phosphate Bone Cement With a Titanium Mesh Sheet

Managing cranial defects complicated by infection remains a clinical challenge. Prior research has shown that bone cement can serve as a drug delivery vehicle, but its mechanical limitations restrict its use. No prior work had resolved how to stabilize large bone defects while delivering antibiotics. This gap motivated the use of a titanium mesh sheet to reinforce antibiotic-impregnated cement. It was already known that methicillin-resistant Staphylococcus aureus infections are difficult to treat. However, the combination of a titanium mesh sheet and drug-loaded cement had not been tested in cranial reconstruction. The uncertainty of infection recurrence in such cases drove this clinical approach. This paper introduces a new application of a titanium mesh sheet in cranial reconstruction.

The aim of this clinical case was to evaluate a novel cranial reconstruction method for infected bone defects. The specific problem addressed was the treatment of a large cranial defect complicated by a methicillin-resistant Staphylococcus aureus infection. The motivation was to find a stable and infection-controlling reconstruction method. Standard bone cement lacks sufficient strength for large defects. A titanium mesh sheet was proposed as a supportive structure. The researchers propose that combining antibiotic-impregnated cement with a titanium mesh sheet could improve outcomes. This paper tests whether this combination is feasible in a clinical setting. The goal was to prevent infection recurrence and structural failure. This approach may offer a new treatment option for similar cases.

The authors used a combination of teicoplanin-impregnated calcium phosphate bone cement and a titanium mesh sheet for cranial reconstruction. The patient had a 4.5 × 8 cm cranial defect following debridement and sequestrectomy. A titanium mesh sheet was placed over the defect to provide structural support. The cement was chosen for its antibiotic delivery properties. Teicoplanin was selected based on sensitivity testing of the causative bacteria. A free rectus abdominis musculocutaneous flap was used for scalp reconstruction. The procedure was followed by postoperative imaging to assess outcomes. The authors monitored for infection recurrence and structural integrity.

At 6 months post-surgery, no infection recurrence was observed in the patient. Computed tomography scans showed no resorption of the calcium phosphate bone cement. The titanium mesh sheet remained intact with no signs of breakage. The patient had no complications related to the reconstruction. The wound culture had previously identified methicillin-resistant Staphylococcus aureus. Teicoplanin was selected based on high bacterial sensitivity. The combination of cement and mesh sheet provided structural stability. The authors report that this method may be useful for similar cases.

The authors propose that combining teicoplanin-impregnated calcium phosphate bone cement with a titanium mesh sheet is a feasible cranial reconstruction method. This approach may be useful for treating large cranial defects with infection. The titanium mesh sheet provides necessary structural support. The cement’s antibiotic properties help control infection. The authors observed no recurrence of infection in this case. Structural integrity was maintained as shown by imaging. The combination addresses both mechanical and infectious challenges. This method may be a viable treatment option for similar clinical scenarios.