What Method Of Skull Reconstruction Should Be Done After An Infection?

Q: Dr. Eppley, I had a skull reconstruction due to a golf ball size defect on the back of my head where the bones meet. I had a Medpor implant placed and it had gotten infected and then caused a skull osteomyelitis. I’ve been told that only fat grafting now is the only treatment option. What about antibiotic PMMA cement? Is there a risk of infection?

A: The most logical next step for skull reconstruction of an occipital skull defect after an infection with Medpor would be antibiotic-impregnated bone cement. Medpor has a notorious history of infection while PMMA bone cement does not. As long as the overlying scalp tissue is adequate thickness and normal vascularity (not been irradiated), PMMA bone cement should have a low risk of infection even with the history of a prior osteomyelitis. I don’t know if what you had constitutes a true osteomyelitis (bone infection) or whether this was more of an implant infection. (which is more likely) Either way PMMA bone cement has a long history of successful use in neurosurgery and orthopedic surgery in bone infections. The slow release of antibiotics from the impregnated cement continues for weeks after surgery.

Dr. Barry Eppley

Indianapolis, Indiana