Polymethylmethacrylate imbedded with antibiotics cranioplasty: An infection solution for moderate and large defects reconstruction?

• Published in: Surgical neurology international Vol. 7; no. Suppl 28; pp. S746 - S751
• Main Authors: Worm, Paulo Valdeci, do Nascimento, Tobias Ludwig, do Couto Nicola, Fabricio, Sanches, Eduardo Farias, Dos Santos Moreira, Carlos Fernando, Rogério, Luiz Pedro Willimann, Dos Reis, Marcelo Martins, Finger, Guilherme, Collares, Marcus Vinicius Martins
• Format: Journal Article
• Language: English
• Published: United States Medknow Publications & Media Pvt Ltd 2016
• Subjects: Original; postoperative complications; neurosurgical procedures; infection; methylmethacrylate; Cranioplast; skull fractures
• ISSN: 2229-5097; 2152-7806; 2152-7806
• DOI: 10.4103/2152-7806.193725

In cases where autologous bone graft reconstruction is not possible (such as comminuted fractures, bone graft reabsorption, or infection) and the use of synthetic material is required, polymethylmethacrylate (PMMA) use is a safe and efficient solution. Studies comparing the incidence of postoperative complications between autologous and synthetic cranioplasty are heterogeneous, not allowing a conclusion of which is the best material for skull defects reconstruction. Current medical literature lacks prospective well-delineated studies with long-term follow-up that analyze the impact of antibiotic use in PMMA cranial reconstruction of moderate and large defects. A prospective series of patients, who underwent cranioplasty reconstruction with PMMA impregnated with antibiotic, were followed for 2 years. Authors collected data regarding demographic status, clinical conditions, surgical information, and its complications. A total of 58 patients completed full follow-up with a mean group age of 40 years and a male predominance (77%). Major complications that required surgical management were identified in 5 patients, and 10 patients evolved with minor complications. Postoperative surgical site infection incidence was 3.2%. The infection rate in patients submitted to PMMA flap cranioplasty impregnated with antibiotic is significantly inferior comparing to the data described in medical literature. A lower infection incidence impacts secondary endpoints such as minimizing surgical morbidity, mortality, hospitalization period, and, consequently, costs.