Abstract：
Bone flap replacement after a decompressive craniectomy is a low complexity procedure, but with complications that can negatively impact the patient\'s outcome. A better knowledge of the risk factors for these complications could reduce their incidence.
A retrospective review of a series of 50 patients who underwent bone replacement after decompressive craniectomy at a tertiary center over a 10-year period was performed. Those clinical variables related to complications after replacement were recorded and their risk factors were analyzed.
A total of 18 patients (36%) presented complications after bone flap replacement, of which 10 (55.5%) required a new surgery for their treatment. Most of the replacements (95%) were performed in the first 90 days after the craniectomy, with a tendency to present more complications compared to the subsequent period (37.8% vs 20%, p > 0.05). The most frequent complication was subdural hygroma, which appeared later than infection, the second most frequent complication. The need for ventricular drainage or tracheostomy and the mean time on mechanical ventilation, ICU admission, or waiting until bone replacement were greater in patients who presented post-replacement complications. Previous infections outside the nervous system or the surgical wound was the only risk factor for post-bone flap replacement complications (p = 0.031).
Postoperative complications were recorded in more than a third of the patients who underwent cranial bone flap replacement, and at least half of them required a new surgery. A specific protocol aimed at controlling previous infections could reduce the risk of complications and help establish the optimal time for cranial bone flap replacement.
A retrospective review of a series of 50 patients who underwent bone replacement after decompressive craniectomy at a tertiary center over a 10-year period was performed. Those clinical variables related to complications after replacement were recorded and their risk factors were analyzed.
A total of 18 patients (36%) presented complications after bone flap replacement, of which 10 (55.5%) required a new surgery for their treatment. Most of the replacements (95%) were performed in the first 90 days after the craniectomy, with a tendency to present more complications compared to the subsequent period (37.8% vs 20%, p > 0.05). The most frequent complication was subdural hygroma, which appeared later than infection, the second most frequent complication. The need for ventricular drainage or tracheostomy and the mean time on mechanical ventilation, ICU admission, or waiting until bone replacement were greater in patients who presented post-replacement complications. Previous infections outside the nervous system or the surgical wound was the only risk factor for post-bone flap replacement complications (p = 0.031).
Postoperative complications were recorded in more than a third of the patients who underwent cranial bone flap replacement, and at least half of them required a new surgery. A specific protocol aimed at controlling previous infections could reduce the risk of complications and help establish the optimal time for cranial bone flap replacement.
摘要：
背景：去骨瓣减压术后骨瓣置换是一种低复杂度的手术，但并发症会对患者的预后产生负面影响。更好地了解这些并发症的危险因素可以降低其发生率。
方法：回顾性分析了50例三级中心去骨瓣减压术后接受骨置换的患者，为期10年。记录与置换后并发症相关的临床变量并分析其危险因素。
结果：共有18例患者（36%）在骨瓣置换术后出现并发症，其中10人(55.5%)需要新的手术治疗。大部分的置换（95%）是在开颅手术后的前90天进行的，与随后的时期相比，有出现更多并发症的趋势(37.8%vs20%，p>0.05)。最常见的并发症是硬膜下积液，比感染更晚出现，第二个最常见的并发症。脑室引流或气管造口术的需要以及机械通气的平均时间，入住ICU,或者在出现置换后并发症的患者中，等到进行骨置换的情况更大。先前神经系统或手术伤口以外的感染是骨瓣置换后并发症的唯一危险因素（p=0.031）。
结论：在接受颅骨瓣置换术的患者中，有超过三分之一的患者发生了术后并发症，至少一半的人需要新的手术.旨在控制先前感染的特定方案可以降低并发症的风险，并有助于确定颅骨皮瓣置换的最佳时间。
方法：回顾性分析了50例三级中心去骨瓣减压术后接受骨置换的患者，为期10年。记录与置换后并发症相关的临床变量并分析其危险因素。
结果：共有18例患者（36%）在骨瓣置换术后出现并发症，其中10人(55.5%)需要新的手术治疗。大部分的置换（95%）是在开颅手术后的前90天进行的，与随后的时期相比，有出现更多并发症的趋势(37.8%vs20%，p>0.05)。最常见的并发症是硬膜下积液，比感染更晚出现，第二个最常见的并发症。脑室引流或气管造口术的需要以及机械通气的平均时间，入住ICU,或者在出现置换后并发症的患者中，等到进行骨置换的情况更大。先前神经系统或手术伤口以外的感染是骨瓣置换后并发症的唯一危险因素（p=0.031）。
结论：在接受颅骨瓣置换术的患者中，有超过三分之一的患者发生了术后并发症，至少一半的人需要新的手术.旨在控制先前感染的特定方案可以降低并发症的风险，并有助于确定颅骨皮瓣置换的最佳时间。
