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Time Interval Reduction for Delayed Implant-based Cranioplasty Reconstruction in the Setting of Previous Bone Flap Osteomyelitis
Joseph Lopez, MD, MBA1, Shuting Zhong, BS2, Eric W. Sankey, BS1, Edward W. Swanson, MD1, Harlyn Susarla, DMD, MPH1, Ignacio Jusue-Torres, MD1, Judy Huang, MD1, Henry Brem, MD1, Paul G. Auwaerter, MD, MBA, FACP1, Chad R. Gordon, DO, FACS1.
1The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2University of Illinois College of Medicine, Rockford, IL, USA.

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.

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