No Differences in Graft Infection: Autologous vs Acrylic Cranioplasty

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Journal name: The Malaysian Journal of Medical Sciences
Original article title: There are No Differences between Factors Determining Graft Infection in Autologous Bone Flap Replacement and Acrylic Cranioplasty: A Prospective Observational Study at Hospital Kuala Lumpur
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Original source:

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Author:

Siti Azleen Mohamad, Mohd Safari Mohd Haspani, Badrisyah Idris


The Malaysian Journal of Medical Sciences:

(A peer-reviewed, open-access journal)

Full text available for: There are No Differences between Factors Determining Graft Infection in Autologous Bone Flap Replacement and Acrylic Cranioplasty: A Prospective Observational Study at Hospital Kuala Lumpur

Year: 2016 | Doi: 10.21315/mjms2016.23.5.11

Copyright (license): CC BY 4.0


Download the PDF file of the original publication


Summary of article contents:

Introduction

Cranioplasty is a surgical procedure aimed at repairing cranial defects caused by trauma or congenital issues, primarily for anatomical restoration, protective purposes, and cosmetic enhancement. This study, conducted at Hospital Kuala Lumpur (HKL) in 2012, focused on determining the incidence of graft infections following cranioplasty and identifying the factors that may influence the graft infection rates. Complications such as graft infection pose a significant risk despite advancements in surgical techniques and graft materials, prompting the need for continuous evaluation of the impacts and effectiveness of different procedures and patient management.

Graft Infection Rates and Influencing Factors

The study included 172 patients who underwent cranioplasty, with a total observed infection rate of 2.9%. Out of the grafts infected, acrylic cranioplasty cases accounted for a higher percentage (4.5%) compared to autologous bone flap replacements (1.9%). The findings indicated that patient outcomes could be influenced by various factors, including the type of graft used, the timing of the cranioplasty after craniectomy, and the patient's pre-operative Glasgow Coma Score (GCS). Despite the variations in graft types, the analysis showed no statistically significant differences in infection rates across genders, graft types, or between patient conditions, emphasizing the complexity of factors affecting graft infection.

Conclusion

The results of the study underscore the persistent challenge of graft infections following cranioplasty, which remain a critical concern in neurosurgical practices. With a relatively low infection rate of 2.9% observed at HKL, this study highlights the importance of meticulous surgical techniques, proper patient selection, and adherence to sterile procedures in mitigating infection risks. While the research did not identify significant associations with common risk factors, it reinforces the need for continuous monitoring and tailored surgical strategies to minimize complications and improve patient outcomes after cranioplasty. Identifying and understanding the multifaceted nature of graft infections is essential for enhancing post-operative care and ensuring effective recovery pathways for patients undergoing these complex procedures.

FAQ section (important questions/answers):

What was the objective of the study on cranioplasty?

The study aimed to determine the incidence of graft infection following cranioplasty procedures and identify factors affecting the graft infection rate at Hospital Kuala Lumpur.

How many patients were included in the cranioplasty study?

A total of 172 patients who underwent cranioplasty at Hospital Kuala Lumpur were included in the study conducted over one year in 2012.

What was the overall infection rate observed in the study?

The overall graft infection rate identified in the study was 2.9%, with five infected grafts among the 172 cases.

What factors were analyzed for association with graft infection?

Factors analyzed included graft type, gender, primary pathology, number of prior procedures, time interval to cranioplasty, and pre-operative Glasgow Coma Score.

Glossary definitions and references:

Scientific and Ayurvedic Glossary list for “No Differences in Graft Infection: Autologous vs Acrylic Cranioplasty”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.

1) Study (Studying):
The study refers to the structured investigation aimed at understanding the incidence of graft infection following cranioplasty procedures. It involved observational methodologies to derive conclusions about risk factors affecting infection rates. The study's methodology, scope, and results contribute to the body of knowledge regarding surgical outcomes and patient care in neurosurgery.

2) Incision:
An incision is a surgical cut made into the skin or tissue, crucial during cranioplasty for accessing the cranial cavity. The type and healing of the incision can significantly impact infection rates, influencing surgical outcomes. Proper incision management is vital to prevent complications such as graft infection and promote recovery.

3) Post:
Post indicates the phase after a surgical procedure, specifically pertaining to post-operative care and monitoring. This period is critical for detecting potential complications like infection. Post-operative evaluations help ensure that any signs of infection are identified early, leading to better treatment outcomes and reduced morbidity for patients following cranioplasty.

4) Sign:
In a medical context, a sign is an objective indication of a disease or condition observed by a clinician. Signs of infection at the surgical site include redness, swelling, or purulent drainage. Recognizing signs early is essential for timely intervention to mitigate complications post-cranioplasty, guiding management decisions.

5) Pur:
Poor health status is associated with increased risks of complications, including infection after surgical procedures. Patients with poor nutritional status or preoperative conditions may have compromised immune responses, affecting wound healing. Understanding the impact of patients' overall health on surgical outcomes can guide interventions aimed at improving recovery prospects.

6) Table:
A table presents data in a structured format, often summarizing results from research studies. In this context, it could display the association between various demographic and clinical variables with infection rates. Tables are vital for visualizing complex information, facilitating easier interpretation and comparison of different factors in study outcomes.

7) Male:
Male refers to the gender of patients and is relevant in the context of the study as it noted a predominance of male subjects. The male gender's specific surgical outcomes, infection rates, and overall health can contribute to understanding potential biological or behavioral differences affecting recovery and complication rates post-cranioplasty.

8) Antibiotic (Antibacterial):
Antibiotics are crucial for treating infections that may arise after surgical procedures, including cranioplasty. Their use needs careful consideration, as overuse can lead to antibiotic resistance. Understanding how antibiotics impact wound healing and infection rates is vital for optimizing post-operative care and reducing the risk of infections.

9) Disease:
Disease refers to any pathological condition that may necessitate cranioplasty, such as traumatic brain injuries or infections. Understanding the underlying diseases can inform surgical strategies and considerations, as the nature of the disease impacts recovery and infection risks. It is essential to consider in patient selection and management.

10) Inflammation:
Inflammation is a biological response to injury or infection, characterized by swelling, redness, and pain. In the context of cranioplasty, inflammation at the surgical site can indicate infection or complications. Understanding the inflammatory process is crucial for managing recovery and preventing serious post-operative outcomes.

11) Knowledge:
Knowledge in this context pertains to the understanding of surgical procedures, potential complications, and infection management in cranioplasty. Continuous medical education and clinical experience enrich a surgeon's ability to minimize risks and enhance patient outcomes, emphasizing the importance of knowledge in optimizing surgical techniques and post-operative care.

12) Fixation:
Fixation usually describes the process of stabilizing an object, such as a bone graft during cranioplasty. Effective fixation techniques are essential for ensuring that grafts integrate properly with surrounding tissues, which is fundamental for successful surgical outcomes and reducing the likelihood of complications like infection.

13) Repair:
Repair refers to the surgical restoration of cranial defects during cranioplasty, using methods such as autologous bone grafts or synthetic materials. Successful repair is crucial for anatomical integrity, brain protection, and aesthetic outcomes. The choice of repair technique influences potential complications, including graft infection rates.

14) Edema (Oedema):
Edema is the accumulation of fluid in tissues that may occur post-surgery. In the context of cranioplasty, edema can complicate recovery and obscure signs of infection. Monitoring and managing edema is critical to minimizing discomfort and preventing further complications during the post-operative phase.

15) Rules:
Rules in this context refer to established guidelines and protocols for surgical procedures, particularly regarding sterility and patient safety. Following proper rules during cranioplasty is essential for minimizing infection risks and ensuring patient safety, emphasizing the importance of adherence to surgical best practices.

16) Sah:
Shah refers to one of the authors mentioned in the context of the study, possibly reflecting contributions to research within the field of neurosurgery. Acknowledging authorship is essential for attributing findings within the scientific community and may provide insight into specific areas of expertise or focus in medical research.

17) Bell:
Bell, mentioned in the references, contributes to the understanding of resorption characteristics of bone and substitutes, relevant in cranioplasty for assessing how different materials behave post-surgery. This knowledge informs surgical decisions and material selection, enhancing overall outcomes and mitigating risks like infection.

18) Pain:
Pain is a common post-operative symptom, and its assessment is vital for evaluating a patient's recovery after cranioplasty. Effective pain management influences a patient's overall experience and may impact their rehabilitation process. Pain can also complicate recovery if linked to infection or other surgical issues.

19) Coma:
Coma refers to a state of prolonged unconsciousness often resulting from brain injury, relevant in assessing patient eligibility for cranioplasty. Glasgow Coma Scale scores provide insight into neurological function and aid in evaluating recovery prospects, influencing surgical decision-making and post-operative care strategies.

20) Tuberculosis:
Tuberculosis (TB) is a serious infectious disease that can complicate neurosurgical interventions. Its presence as a consideration in exclusion criteria underscores the importance of ruling out infectious diseases before cranioplasty, as such conditions can severely impact healing and the risk of post-operative infections.

21) Observation:
Observation in a medical context relates to the close monitoring of patients post-surgery for signs of complications, including graft infections. Effective observation is critical in the post-operative phase for early identification and intervention, significantly influencing overall patient outcomes and reducing morbidity.

22) Discussion:
Discussion represents the analytical interpretation of study findings, allowing researchers to articulate the significance of results in the context of existing literature. Engaging in discussion is vital for advancing knowledge, identifying limitations, and proposing future research directions to enhance understanding in neurosurgical practices.

23) Substance:
Substance can refer to any material used in surgical procedures, such as graft materials in cranioplasty. The choice of substance directly impacts infection risks and patient outcomes. Knowledge about the properties and behaviors of various substances is crucial for optimizing surgical techniques and improving post-operative care.

24) Attending:
Attending in a medical context usually denotes a supervising physician or surgeon responsible for patient care. Their expertise is vital in ensuring high-quality surgical procedures and post-operative management. The attending’s role encompasses oversight, decision-making, and patient interactions that contribute to effective care and outcomes.

25) Suffering:
Suffering relates to the physical and psychological distress experienced by patients, often intensified by surgical complications like infection. Understanding patients' suffering helps guide compassionate care and informs healthcare providers to provide support and alleviate discomfort during recovery from cranioplasty.

26) Swelling:
Swelling is often indicative of inflammation or infection at the surgical site, making it a key observation in post-operative assessments. Monitoring swelling helps determine recovery progress and potential complications, guiding timely clinical interventions to optimize healing after cranioplasty procedures.

27) Training:
Training denotes the education and skills development for medical professionals, particularly neurosurgeons, crucial for performing complex procedures like cranioplasty. Proper training ensures adherence to surgical protocols and techniques, directly influencing patient outcomes and minimizing the risk of complications such as infections.

28) Hygiene (Hygienic):
Hygiene emphasizes the importance of maintaining cleanliness to prevent infections during and after surgical procedures. In the context of cranioplasty, strict hygiene practices are essential to minimize infection risks, highlighting the need for both surgical and post-operative hygiene protocols in patient management.

29) Reason:
Reason pertains to the rationale behind clinical decisions, including surgical approaches and post-operative care strategies. Understanding the reasons behind certain methodologies helps enhance surgical outcomes and improve patient safety by guiding best practices based on evidence and experience.

30) Fever:
Fever is a potential indicators of infection post-surgery and requires careful monitoring in patients following cranioplasty. An elevated temperature may necessitate further investigation to determine underlying causes, and timely intervention can help mitigate complications, improving overall patient outcomes.

31) Visit:
Visit refers to follow-up appointments where patients are assessed after surgery for signs of complications such as infection. These visits are crucial for ensuring proper recovery management and intervention, allowing healthcare providers to monitor healing and address any emerging issues promptly.

32) Pose:
Pose signifies the implications or challenges associated with surgical procedures. In cranioplasty, complications can pose risks to patient health, necessitating vigilance and proactive management strategies to mitigate issues like infection and ensure optimal surgical outcomes.

33) Hand:
Hand often relates to the skills and dexterity required in surgical procedures. The surgeon's hand plays a crucial role in performing delicate tasks during surgeries, directly impacting the quality of care and outcomes, emphasizing the importance of manual skills in cranioplasty.

34) Burning (Burn, Burned, Burnt):
Burn may refer to thermal injuries that can occur during the use of certain substances like methyl methacrylate in cranioplasty procedures. Understanding the potential for burns highlights the need for careful application of materials and techniques to reduce complications during surgery.

Other Science Concepts:

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Discover the significance of concepts within the article: ‘No Differences in Graft Infection: Autologous vs Acrylic Cranioplasty’. Further sources in the context of Science might help you critically compare this page with similair documents:

Inflammation, Patient care, Wound infection, Wound healing, Statistical analysis, Health care, Time interval, Patient, Wound healing process, Patient selection, Nutritional status, Patient Monitoring, Female patient, Economic burden, Post-operative period, Functional status, Antibiotic resistance, Statistically significant difference, Hospital stay, Risk factor, Glasgow Coma Scale, Surgical site infection, Surgical technique, Bacterial translocation, Hemostasis, Hydrocephalus, Underlying disease, Traumatic brain injury, Hospital acquired infection, Increased risk, Surgical wound, Graft failure, Poor nutritional status, Infection rate, Glasgow coma score, Operating room, Neurosurgeon, Surgical complication, Group 1, Group 2, Male patient, Infection, Autologous bone, Post operative complication, Sterile environment, Late complications, Graft material, Neurologic Condition.

Concepts being referred in other categories, contexts and sources.

Study, Strict adherence, Procedure.

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