Analysis of the factors affecting outcome after combat-related cranial defect reconstruction

Summary Introduction Reports on the outcomes of cranioplasty after combat-related injuries are relatively rare in the current literature. We present our results on the reconstruction of cranial defects resulting from injuries sustained in combat, comparing outcomes using autologous (iliac bone) graf...

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Bibliographic Details
Published in:Journal of cranio-maxillo-facial surgery 2017-02, Vol.45 (2), p.312-318
Main Authors: Pavlićević, Goran, PhD, Lepić, Milan, MD, Perić, Predrag, PhD, Ivetić, Dražen, MD, Roganović, Ana, MD, Roganović, Zoran, PhD
Format: Article
Language:English
Subjects:
Adolescent
Adult
Allografts - surgery
Autografts - surgery
Bone Transplantation - methods
Cranioplasty
Dentistry
Firearm injury
Head trauma
Humans
Male
Middle Aged
Military Medicine - methods
Outcome
Postoperative Care
Reconstructive Surgical Procedures - methods
Skull - injuries
Skull - surgery
Surgery
Treatment Outcome
War surgery
Warfare
Young Adult
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Summary:Summary Introduction Reports on the outcomes of cranioplasty after combat-related injuries are relatively rare in the current literature. We present our results on the reconstruction of cranial defects resulting from injuries sustained in combat, comparing outcomes using autologous (iliac bone) grafts or (acrylate) allografts, and analysis of other factors that may influence the final outcome. Material and Methods The study comprised 207 patients with cranial defects resulting from combat-related injuries, repaired with autografts or allografts. The final outcome was defined at least 5 years postoperatively on the basis of cosmetic restoration and the existence of complications as successful (acceptable cosmetic restoration + absence of complications) or unsuccessful (poor cosmetic restoration or acceptable cosmetic restoration + complications). Results Successful outcomes were achieved in 83.6% of patients; there was no operative mortality. There were 25 instances of complications: postoperative infection (n=15, allograft (7/53), autograft (8/154)), autograft resorption (n=8), and in two cases, graft luxation. Poor cosmetic restoration was noted in 9 (4.3%) patients who had received an autograft. Conclusions Thin and poorly vascularized skin, a surface area of the defect larger than 88 cm2 , previous local infection and communication with paranasal cavities significantly influenced outcomes after combat-related cranioplasty, the final three being independent predictors of an unsuccessful outcome.
ISSN:1010-5182
1878-4119
DOI:10.1016/j.jcms.2016.11.019