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BACKGROUND: Re-infections following implant-based cranioplasty, in the setting of previous bone flap osteomyelitis, is unfortunately common and accompanies significant morbidity. Currently, the timing of reconstruction following initial osteomyelitic bone-flap removal remains controversial; with most advocating for prolonged time intervals around 6-12 months. With this in mind, we chose to investigate our delayed cranioplasty outcomes following both "early" (3 months) and "late" (>6 months) time intervals with custom cranial implants to determine if timing affected outcomes and rates of re-infection.
METHODS: A retrospective cohort review of 25 consecutive cranioplasties performed at a multidisciplinary center was conducted under IRB approval. A non-parametric bivariate analysis compared variables and complications between the two different time interval groups defined as: "early" cranioplasty (between 90-179 days) and "late/delayed" cranioplasty (≥180 days).
RESULTS: No significant differences were found in primary and secondary outcomes in patients who underwent early (mean=4 months) vs late (mean=8 months) delayed cranioplasty (p>0.29). The overall re-infection rate was only 4% (1/25) – with the single re-infection occurring in the "late" group. Overall, the major complication rate was 8% (2/25). Complete and subgroup analyses of specific complications yielded no significant differences between the early and late time intervals (p>0.29).
CONCLUSION: Our results suggest that "early" delayed cranioplasty (around 3 months) is a viable treatment option for patients with previous bone flap osteomyelitis and subsequent removal. As such, a reduced time interval of three months - with equivalent outcomes and re-infection rates - represents a promising area for future study and aims to reduce the morbidity surrounding prolonged time intervals.