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HomeHealth articlesexposure of titanium implants after cranioplastyWhat Are the Risks of Titanium Implant Exposure After Cranioplasty?

Exposure of Titanium Implants After Cranioplasty

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Titanium implant exposure is a well-known complication of titanium mesh cranioplasty and is often treated with implant removal or exchange.

Written by

Dr. Sameeha M S

Medically reviewed by

Dr. Shivpal Saini

Published At May 14, 2024
Reviewed AtMay 16, 2024

Introduction

Titanium plates for cranioplasty are considered safe for human implantation, and they are one of the most commonly utilized biomaterials for skull fixation or reconstruction. Even though the application of titanium implants in cranioplasty has become more popular, the long-term outcomes of this method can be challenging to maintain. In various neurosurgeries where titanium plates have been utilized, the infection rate is roughly five percent, and removal is necessary in one percent of all instances. Titanium mesh cranioplasty is becoming more popular because it prevents cosmetic deformity, lessens the susceptibility of vulnerable brain structures, and reduces the risks and expenses associated with other treatments.

What Is Cranioplasty?

Cranioplasty is a type of surgery that repairs a bone deficiency in the skull caused by a previous operation or accident. There are various types of cranioplasties, but the majority involve elevating the scalp and reconstructing the contour of the skull using either the original skull part or a custom molded graft produced from materials like titanium (plate or mesh) or artificial bone substitute (liquid), or solid biomaterial (customized implant constructed to fit the contour and form of the skull).

Why Does Someone Require Cranioplasty?

Cranioplasty can be done for a variety of reasons, including:

  • Protection: In some cases, a cranial deformity might expose the brain to injury. Cranioplasty has been shown to improve neurological function in some patients. In some cases, a unique cranial implant is constructed to assist the surgeon in achieving the desired form and result.

  • Aesthetics: A visible skull deformity can have an impact on a patient's appearance and confidence. In such cases, cranioplasty is required to correct the deformity.

  • Headaches: Cranioplasty can help with headaches caused by earlier surgery or damage.

What Is Titanium Mesh Cranioplasty?

Titanium mesh cranioplasty is a type of surgery in which titanium is used as an implant material. Numerous skull-related issues can be corrected using titanium mesh. Applications of it include cosmetic irregularities, lowering the vulnerability of exposed brain tissue, cancer, or a brain tumor. Titanium mesh cranioplasty surgery is done in such a way that patients are first sedated with an anesthetic. The surgeon then delicately slices the patient's scalp into several layers. This safeguards the brain and ensures that the surgeon does not inadvertently cause problems with the brain. After cleaning the bone's borders, the surface is made ready for the implant, ensuring it can properly fix the existing deficiency.

The titanium mesh layer is secured to the skull bones with screws. Following implant placement, the bleeding is controlled, the scalp returns to its previous position, and the incision area is sutured up. There are several types of titanium mesh implants based on where they are used. This diversity in the usage of titanium as a suitable material to correct for flaws in practically all sections of the body suggests that the material appears most compatible with the human body. As a result, its application in the skull may be appropriate. However, because each person's anatomy and physique are unique, the surgeon may still recommend treatments or other materials to address the issue.

What Are the Complications of Titanium Mesh Cranioplasty?

  • The cranioplasty site is susceptible to infection, like with any surgical operation. Infections may necessitate additional surgeries, antibiotic therapy, and implant removal.

  • The titanium mesh implant could move or go out of place from where it was supposed to be. This may happen as a result of poor fixation, poor surgical skill, or trauma.

  • The implant may occasionally become visible through the surrounding soft tissue. Discomfort, pain, and a possible infection might result from this.

  • The incision site may not heal properly, which could result in a delayed healing process, wound deterioration, and a higher risk of infection.

  • Although titanium is generally well-tolerated by the body, some patients may develop allergies.

What Are the Risks of Titanium Implant Exposure After Cranioplasty?

Even though titanium implants are generally tolerated well, erosion of the underlying soft tissue due to implant exposure remains an important risk that might negatively impact patients' outcomes. After a cranioplasty, titanium implant exposure occurs when the titanium mesh or plate that was used to reconstruct the skull may be seen through the skin or soft tissue. This could be a surgical treatment complication and carry a number of risks and complications.

Some of the risks associated with titanium implant exposure after cranioplasty are the following.

  • Titanium Implant exposure allows microorganisms to enter the implant and perhaps cause an infection. Infections in the implant location can be difficult to cure and may necessitate the removal of the implant followed by a course of antibiotics.

  • When the implant is exposed, there is a greater chance that it will shift or move out of its intended position (implant extrusion). This might compromise the skull's structural integrity and may demand additional surgery to relocate or remove the implant.

  • The exposed titanium implant has the potential to harm or irritate the surrounding soft tissues, resulting in inflammation, necrosis of the tissue, or scarring.

  • The exposed implant might inflame nearby tissues and cause lingering pain.

Titanium mesh exposure during cranioplasty surgery may have an impact on the cranioplasty success rate. Female predominance, prolonged surgery, and substantial intraoperative blood loss may be associated with a risk of titanium mesh exposure. To avoid this, accurate preoperative planning, maintenance of scalp vascularization, minimization of surgical time, and precise wound care are required. Following a cranioplasty, patients must carefully adhere to their post-operative instructions and attend follow-up sessions in order to check for any indications of implant exposure or other issues. The risks and adverse effects of implant exposure can be reduced with early detection and management.

Conclusion

The management of titanium implant exposure following cranioplasty is determined by the extent of the exposure, the patient's general condition, and the underlying cause. In less serious situations, wound care and medications may be enough to encourage healing and stop infection. However, in more severe situations, surgery might be necessary to treat implant exposure and related issues, including implant removal or revision surgery.

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Dr. Shivpal Saini
Dr. Shivpal Saini

General Surgery

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