Page 77 - Clinical relevance of current materials for cranial implants

Defect size
Larger craniectomies are considered an essential means of decompression as a life-
saving intervention. However, a larger size of the defect tended to foster bone flap
resorption. This possible correlation is supported by previous studies, showing that
cranial defects above 75cm2 were associated with a resorption rate above 60%.13 Fan
et al.37 reported a significant correlation between bone resorption and cranial defects 3 larger than 100 cm2. On the other hand, Schoekler and Trummer reported a slightly
higher resorption rate in patients with cranial defects over 120 cm2, but did not find a significant correlation16. Similarly, Dünisch et al. did not show a significant association between complications and the size of the defect22. Bone graft incorporation depends on the amount of vascularization and resumption of osteogenesis in terms of the formation of bone bridges between the outline of the cranial defect and the reimplanted autologous bone flap.38 With a larger defect size more revascularization and bone formation needs to occur, which may imply that resorption in larger defects is more likely.
Duration of hospitalization after decompressive craniectomy
In the present study, an association was found between the duration of hospitalization after decompressive craniectomy and the overall complication rate, as well as the infection rate. This may be caused by the overall condition of the patient, comorbidities, newly developed diseases, neurological and surgical outcomes, complications, and rehabilitation period after decompressive craniectomy1. To better understand the predictive factors that influence complication rates after cranioplasty, and thereby the length of hospital stay, the surgical outcomes after decompressive craniectomy need to be quantified. Early recovery programs after surgery are known to shorten the length of stay39, and may also be applicable in acute situations like cranial decompression surgery to reduce the risk of eventual flap failure.
Autologous cranioplasty
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