Layered suspension fixation and comprehensive management prevent subcutaneous effusion after polyetheretherketone...

Subcutaneous effusion (SCE) is an increasingly prevalent complication of polyetheretherketone (PEEK) cranioplasty, with no effective preventive strategies established to date. This case series aimed to explore interventions for reducing SCE incidence in such patients.

A retrospective analysis was performed on 33 patients who underwent PEEK cranioplasty at our institution from July 2023 to December 2025. Intraoperatively, the layered suspension fixation method (LSFM) was adopted to suture subcutaneous tissues and underlying muscles to the PEEK implant, minimizing subcutaneous dead space, and this was combined with a comprehensive postoperative management strategy. The incidences of SCE and other postoperative complications were statistically analyzed.

Thirty-three patients (36 cranial sides) were enrolled, with a median age of 53 years (IQR=21.5); 66.67% were male, and 90.9% had unilateral defects; traumatic brain injury (63.64%) was the primary indication for prior decompressive craniectomy. The mean cranial defect area was 72.40 ± 20.89 cm², the median interval from craniectomy to cranioplasty was 5 months, and the mean operative duration was 1.92 ± 0.40 h. Postoperative management included enhanced fluid replacement, gravity drainage, and compressive bandaging. No SCE was observed during hospitalization or follow-up. The overall complication rate was 15.15% , including 3 cases of self-resolving epidural effusion (9.09%). No severe complications occurred, and the mean aesthetic score was 5 points. The preoperative third ventricular width showed a non-significant reduction postoperatively (P>0.05).

LSFM combined with comprehensive postoperative management can significantly reduce the incidence of SCE following PEEK cranioplasty, ensure secure fixation of the temporal muscle to prevent displacement and ptosis, and achieve favorable aesthetic outcomes, thus serving as a simple and feasible approach.