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Advanced Neurology Outcomes of implant usage for depressed skull fractures

post-operative complications associated with autologous implant design (Y). Although autologous implants show
implants, it is possible that there may be a preferential bias desirable biomimetic properties, they display a variable
towards the use of allogenic grafts for reconstruction of the reabsorption rate between 3% and 50%, leading to failure
frontal skull bone; however, it is also possible that these of the implant (Y). Nonautologous implants may overcome
observations could be due to the relatively small sample these disadvantages of autologous material; however they
size of the studied patient population . Thus, further may be associated with their own shortcomings such as
[35]
investigation of the association between the location of higher infection rate or higher costs. Due to these proposed
fracture reconstruction and post-operative outcomes differences, we analyzed post-operative complication rates
associated with the type of implant material is warranted. between patients utilizing autologous or nonautologous
graft material (Table 4). Of 145 patients with an autologous
Perioperative characteristics were also comparatively
assessed to identify differences associated with operative graft, 4.14% (6/145) had experienced at least one post-
operative complication. This was compared against the
considerations and selection of implant material. Although nonautologous patient sample in which 3.13% (1/32) of
studies have reported reduced incidence of post-operative patients reported at least one post-operative complication,
infection attributable to delayed surgical intervention, resulting in a mean complication rate of 4% across groups.
clinical equipoise remains as to the optimal timing of Thus, there was no significant difference in complication
operation post-injury given conflicting evidence in the rate between both groups. The previous literature reports
literature [36-38] . There is more consensus in the literature, minor complications usually occur within the first 2 –
however, that immediate cranioplasty following injury 3 months after cranioplasty, and major complications
should be restricted to the removal of damaged bone, occur around 6 months after surgery (Y). Both patients
and later followed by cranioplasty in a staged surgical in the autologous and nonautologous groups had a
approach [8,33,38] . As such, we investigated whether this mean follow-up time of 13.2 months, 14.5 months in the
equipoise persists in consideration of DSF reconstructions autologous group and 11.2 months in the nonautologous
utilizing autologous or non-autologous implant material group, thus allowing adequate time for the occurrence of
(Table 3). In comparing the duration of time between injury complications. The outcome of depressed skull fractures
and cranioplasty between both cohorts, we identified a has been significantly associated with GCS, with patients
mean duration of 11.43 days among the autologous implant scoring between 13 and 15 having fewer complications
cohort as compared to a mean duration of 10.27 days in the (Z) , which allows for accurate comparison between both
[41]
non-autologous implant cohort (Table 3). This slight delay autologous and nonautologous groups with a similar GCS
in intervention time among the autologous cohort may be of 15 and 14.75 for the autologous and nonautologous
indicative of a deliberate attempt to reduce postoperative groups, respectively. The length of stay was significantly
infection, which is supported as a precautionary measure different between the two groups, with 36.3 days for patients
given the lower preoperative GCS observed in this cohort receiving an autologous implant and 16.7 days for patients
(Table 2). We additionally compared the average length receiving a nonautologous implant (p = 0.0274). Although
of stay between both cohorts to determine whether hospital length of stay is commonly used as a measure of
DSF reconstruction utilizing either autologous or non- quality of care, there were no significant differences in
autologous implant material was associated with improved post-operative complication rates with longer hospital stay
post-operative outcomes. This revealed a significant following cranioplasty with an autologous implant when
statistical difference between the autologous and non- compared with shorter hospital stay in the nonautologous
autologous cohorts (36.3 days vs. 16.7 days, p = 0.0274), implant group.
which supports the possibility that enhanced postoperative
outcomes can be achieved through use of non-autologous We confer there were few limitations to the present
implant material (Table 4). systematic review. Due to the stringency of the chosen
inclusion criteria, a minority of studies that met the
In addition, post-operative outcomes were analyzed requirements were included in the present analysis. The
between patients with autologous or nonautologous relationship between perioperative characteristics and
implant material. The previous literature has shown no outcomes were also difficult to establish across groups
significant difference in post-operative outcomes between due to the variable length of follow-up across studies.
different implant materials [39,40] , but male patients, patients Moreover, a larger, non-homogeneous sample is desired
with complex injuries, and cases with involvement of the to resolve a generalizable relationship between patient
frontal sinus experienced a higher risk of postoperative outcomes related to receiving autologous or nonautologous
complications . Zanotti et al. additionally reported implants. The autologous patient population was
[39]
that complications after cranioplasty are influenced by predominantly young adult males, whereas the non-

Volume 2 Issue 1 (2023) 8 https://doi.org/10.36922/an.247