gms | German Medical Science

Objective: Cranioplasty using autologous bone grafts or alloplastic implants are associated with risks of bone resorption, infection and/or protrusion through the skin. Wound dehiscence with implant exposure and signs of infection usually calls for implant removal in order to avoid serious complications.

Methods: In a cohort of 69 patients having received a custom made ceramic implant a total of 6 wound dehicences with implant exposure were encountered. The wound dehiscences occurred in 4 female and 2 male patients out of which half had been treated initially for either a traumatic brain incident or tumor growth. 4 patients had suffered from previous implant failures due to infection or extensive postoperative oedema. In all cases the wound opening occurred through the incision located over the implant exposing the implant surface. In these patients wound edges were revised and superficial layers of the exposed ceramic surface of the implant were trimmed using a scalpel in order to mechanically remove any potential contaminant. Thereafter, the area was treated with antibiotics and, due to often very fragile and thin patient skin, the wound openings were closed with various skin flap techniques.

Results: Out of the 6 patients who underwent wound revision 5 recovered well and followed an expected post-operative course. Only 1 patient suffered from a persistent wound dehiscence with multiple wound infections which lead to the implant being removed six months post-surgery.

Conclusion: In case of a wound dehiscence the selected course of action might not necessarily be explantation. The custom made design and structure of an implant may enable either partial removal or trimming of an implant without the need to remove the entire implant.