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2022, Vol. 26 ›› Issue (16): 2522-2525Reasons for failure of silica gel and titanium mesh in cranioplastyZhao Haifeng1, Dai Yiping2, Zhu Wenyu3, Yan Ke3, Wang Yu3, Wu Jie3, Gu Donghua1, Xu Xiaofeng2, Cao Longxing2, Huang Qiang4
Abstract: BACKGROUND: Cranioplasty has a long history, but the choice of implant materials has been inconclusive, although constantly updated, ideal implant materials remain unavailable. OBJECTIVE: To analyze the reasons for the failure of silica gel and titanium mesh for cranioplasty. METHODS: Five patients with complete long-term follow-up data were selected, including two males and three females, with an average age of 53 years. After cranioplasty, a total of eight operations were performed, including three times of silica gel removal, three times of titanium mesh removal, twice of incision resuture and retaining titanium mesh. The shortest interval duration from cranioplasty was 2 months, and the longest was 20 years. The first symptom was implant exposure or infection. The implant material was mainly silica gel, and the other was incision doubling, and most were titanium mesh. All cases were scanned by CT before and after operation. Combined with clinical symptoms, patients who were considered impossible to be cured without removal of implant materials were surgically removed, and tissues removed by debridement were analyzed by pathology. RESULTS AND CONCLUSION: (1) Three cases of silicone and titanium mesh implants were removed respectively, besides rejection reaction, incidental folliculitis and external force impact were also contributing factors to the failure of cranioplasty; the latency period of onset was 2 months to 20 years, mainly manifested as infection in the surgical area and exposure of implant materials. (2) In addition to the common leukocyte infiltration, integrin-X subunit (CD11c) and bone morphogenetic protein were also expressed in inflammatory tissues in cases with inflammation on CT imaging. (3) The results show that the sustained rejection reaction lasting for months, years or even decades was the root cause of the failure of silicone and titanium mesh implantation. Occasional scalp folliculitis and external force impact were the triggers. The newly discovered osteogenic reaction on pathological sections remains to be further verified. Key words:bone, materials, implant materials, cranioplasty, complications, inflammatory histopathology, CT imaging |