Available online 5 January 2013
Publication year: 2013
Source:World Neurosurgery
Introduction Bone flap infections following autogenous cranioplasty can present a diagnostic and management challenge. Little is known about the clinical, radiological and microbiological profile of these patients. Methods Patients who developed bone flap infective complications requiring explantation following autogenous cranioplasties between 1999 and 2009 were identified. Their prospectively collected demographic details, clinical presentation, radiological features, surgical intervention, microbiological profile and treatment outcomes were retrospectively reviewed. Results During the study period, 179 cranioplasties were performed using frozen autogenous skull flaps. Seventeen patients (10%, median age 25 years) were complicated by deep infection necessitating flap removal and antimicrobial treatment. While fever, scalp swelling and local inflammation were present in majority of patients (76.5%), inflammatory markers were abnormal only in 33%. CT imaging features included: extra-axial collection (76.5%), subgaleal collection or galeal swelling (70.6%), cerebritis (37.5%) and osteomyelitis (23.5%). Positive bacterial cultures were obtained from all (100%) explanted bone-flaps, including gram positive (82.3 %) and negative (17.7%) organisms. Significant proportion (29.4%) of patients presented late (>6 weeks), 60% of these were due to Propionibacterium acnes infection. Conclusions Clinical assessment is critical to the diagnosis of bone flap infection. A high index of suspicion is necessary as late presentations are possible. Empirical antimicrobial treatment should include gram-negative coverage.
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