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Determinants of Titanium Hardware Exposure Following Cranioplasty: A Case-Control Study.
Katerina Green1, Rockey Dahiya1, Natalie Weiss1
1Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic.
The Journal of Craniofacial Surgery
|May 15, 2026
Summary
Titanium mesh cranioplasty has risks. Metal allergy and advancement flaps increase exposure, while radiation and rotational flaps offer protection. Early wound monitoring is key for better outcomes.
Area of Science:
- Neurosurgery
- Plastic Surgery
- Biomaterials Science
Background:
- Titanium mesh is widely used for cranioplasty.
- Hardware exposure is a significant complication, reported in up to 25% of cases.
- Identifying risk factors and early warning signs is crucial for improving patient outcomes.
Purpose of the Study:
- To identify risk factors for titanium mesh exposure after cranioplasty.
- To characterize early wound changes indicative of impending hardware exposure.
Main Methods:
- Retrospective review of 34 patients undergoing titanium mesh cranioplasty (2015-2025).
- 1:1 matching of 17 patients with hardware exposure to 17 controls.
- Analysis of demographics, comorbidities, operative details, and complications using Fisher exact test and t tests (P<0.05).
Main Results:
- History of metal allergy and use of advancement flaps were significant risk factors for exposure.
- Postoperative radiation therapy and use of rotational flaps were significant protective factors.
Conclusions:
- Titanium mesh exposure risk is associated with metal allergy history and advancement flaps.
- Postoperative radiotherapy and rotational flaps may reduce exposure risk.
- Early recognition of wound changes and close postoperative monitoring are vital for successful cranioplasty.