Implant-retaining management of cranioplasty-related surgical infections

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.

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.

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.

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.