povidone-iodine and Craniocerebral-Trauma

OBJECTIVE The aim of this study was to investigate the long-term therapeutic efficacy of cranioplasty with autogenous bone flaps cryopreserved in povidone iodine and explore the risk factors for bone resorption. METHODS Clinical data and follow-up results of 188 patients (with 211 bone flaps) who underwent cranioplasty with autogenous bone flaps cryopreserved in povidone-iodine were retrospectively analyzed. Bone flap resorption was classified into 3 types according to CT features, including bone flap thinning (Type I), reduced bone density (Type II), and osteolysis within the flaps (Type III). The extent of bone flap resorption was graded as mild, moderate, or severe. RESULTS Short-term postoperative complications included subcutaneous or extradural seroma collection in 19 flaps (9.0%), epidural hematoma in 16 flaps (7.6%), and infection in 8 flaps (3.8%). Eight patients whose flaps became infected and had to be removed and 2 patients who died within 2 years were excluded from the follow-up analysis. For the remaining 178 patients and 201 flaps, the follow-up duration was 24-122 months (mean 63.1 months). In 93 (46.3%) of these 201 flaps, CT demonstrated bone resorption, which was classified as Type I in 55 flaps (59.1%), Type II in 11 (11.8%), and Type III in 27 (29.0%). The severity of bone resorption was graded as follows: no bone resorption in 108 (53.7%) of 201 flaps, mild resorption in 66 (32.8%), moderate resorption in 15 (7.5%), and severe resorption in 12 (6.0%). The incidence of moderate or severe resorption was higher in Type III than in Type I (p = 0.0008). The grading of bone flap resorption was associated with the locations of bone flaps (p = 0.0210) and fragmentation (flaps broken into 2 or 3 fragments) (p = 0.0009). The incidence of bone flap collapse due to bone resorption was higher in patients who underwent ventriculoperitoneal (VP) shunt implantation than in those who did not (p = 0.0091). CONCLUSIONS Because of the low incidence rates of infection and severe bone resorption, the authors conclude that cranioplasty with autogenous bone flaps cryopreserved in povidone-iodine solution is safe and effective. The changes characteristic of bone flap resorption became visible on CT scans about 2 months after cranioplasty and tended to stabilize at about 18 months postoperatively. The bone resorption of autogenous bone flap may be classified into 3 types. The rates of moderate and severe resorption were much higher in Type III than in Type I.

Topics: Adult; Bone Resorption; Brain Neoplasms; Cerebral Hemorrhage; Craniocerebral Trauma; Decompressive Craniectomy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Plastic Surgery Procedures; Postoperative Complications; Povidone-Iodine; Retrospective Studies; Skull; Surgical Flaps

Topics: Aged, 80 and over; Anti-Infective Agents, Local; Craniocerebral Trauma; Extravasation of Diagnostic and Therapeutic Materials; Humans; Lacerations; Male; Microsomes; Povidone-Iodine; Syncope; Tomography, X-Ray Computed

Several approaches exist for the treatment of animal attacks targeting the head and neck region. The treatment options and timing vary depending on the animal species, the nature of the defect, and the experience of the surgeon. In this study, early surgical treatment options used in head-neck injuries caused by domesticated or wild animal attacks are presented.We consider 12 patients who were admitted to our clinic between June 2006 and May 2010 with head-neck injuries caused by animal attacks. Tissue defect had developed in 10 patients due to half-wild dog bite and in 2 patients due to wolf bite. The ages of the patients ranged from 3 to 45 years (mean, 21.3 years). Among the patients included in the study, 4 had facial injury, 3 had ear, 3 had scalp, 1 had eye, and 2 had nose injuries. In all patients, early surgical reconstruction was performed after irrigation, antisepsis, and debridement. Concurrent rabies and tetanus prophylactic antibiotherapy program was started.Infection or surgical complications were not observed in any of the patients. Rabies symptoms were determined in one of the quarantined dogs under surveillance. There were no positive findings in the patient bitten by the dog. The surgical treatment results from all patients were at satisfactory levels.As a result, it is observed that, in the treatment of head and neck injuries resulting from animal bites, early acute approach has replaced the traditional long-term treatment. We believe that debridement and early surgical reconstruction used in combination with medical support and prophylactic treatment are the best treatment method.

Topics: Adolescent; Adult; Animals; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Bites and Stings; Child; Child, Preschool; Craniocerebral Trauma; Debridement; Dogs; Ear, External; Eye Injuries, Penetrating; Facial Injuries; Female; Follow-Up Studies; Humans; Lacerations; Male; Middle Aged; Neck Injuries; Nose; Plastic Surgery Procedures; Povidone-Iodine; Rabies Vaccines; Scalp; Surgical Flaps; Tetanus Toxoid; Wolves