Risk Factors for Titanium Mesh Implant Exposure Following Cranioplasty

• Published in: Canadian journal of plastic surgery Vol. 25; no. 2; p. 129
• Main Authors: Maqbool, T, Binhammer, A, Binhammer, P, Antonyshyn, O
• Format: Journal Article
• Language: English
• Published: Montreal SAGE PUBLICATIONS, INC 01.07.2017
• Subjects: Radiation therapy; Risk factors; Titanium
• ISSN: 2292-5503; 2292-5511

Purpose: Titanium mesh (Ti-mesh) is an alloplastic implant that is often used in cranial vault reconstruction. Though it is generally well-tolerated, erosion of the overlying soft tissue with exposure of the implant is a late complication that adversely affects patient outcomes. The purpose of this study is to investigate potential risk factors of Ti-mesh exposure. Method: The study series comprises all consecutive patients who underwent Ti-mesh cranioplasty by 1 surgeon at 1 institution between January 2000 and July 2016. A retrospective chart review was conducted to extract data describing demographics, defect characteristics, details of surgery and perioperative radiotherapy. The latest post- operative computerized tomography (CT) scans were reviewed in each case to document the thickness of soft tissue coverage over Ti-mesh and the depth of extradural dead space deep to the implant. Results: Fifty patients had Ti-mesh cranioplasty, and 8 (16%) developed implant exposure (complete = 6, threatened = 2). Age, sex, defect size, etiology or anatomical site were not significant risk factors for exposure complication. In the exposure group, 4 (50%) underwent a free flap tissue transfer for implant coverage [non-exposure: 5 (11.9%) patients, P = .03], and 4 (50%) received pre-operative radiotherapy [nonexposure: 3 (7.1%), P = .009]. There were no significant associations between the use of transposition/rotation flap (37.5% in exposure group vs 19%, P = .35) and post-operative radiotherapy (0% vs 14.3%, P = .57), and exposure. Postoperative CT scans revealed significant thinning of soft tissues over mesh in 7 (87.5%) exposure patients [non-exposure: 15 (35.7%), P = .007]. No significant association was found between exposure and presence of dead space (62.5% vs 42.9%, P = .44). Conclusion: Preoperative radiotherapy, free flap coverage, and soft tissue atrophy are significant risk factors for titanium mesh exposure. Future studies should characterize the mechanistic relationship between identified risk factors and exposure. Learning Objective: (1) To identify and discuss risk factors for titanium mesh exposure in cranioplasty patients.