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2017 ; 8
(ä): 189
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Never say never again: A bone graft infection due to a hornet sting, thirty-nine
years after cranioplasty
#MMPMID28868201
Maugeri R
; Giammalva RG
; Graziano F
; Basile L
; Gulì C
; Giugno A
; Iacopino DG
Surg Neurol Int
2017[]; 8
(ä): 189
PMID28868201
show ga
BACKGROUND: Cranioplasty (CP) is a widespread surgical procedure aimed to restore
skull integrity and physiological cerebral hemodynamics, to improve neurological
functions and to protect the underlying brain after a life-saving decompressive
craniectomy (DC). Nevertheless, CP is still burdened by surgical complications,
among which early or late graft infections are the most common
outcome-threatening ones. CASE DESCRIPTION: We report the case of 48-year-old man
admitted to our neurosurgical unit because of a painful right frontal swelling
and 1-week purulent discharge from a cutaneous fistula. He had been undergone
frontal CP because of severe traumatic brain injury (TBI) when he was 9-year-old.
Since then, his medical history has been being unremarkable without any surgical
or infective complication of the graft for 39 years, until he was accidentally
stung by a hornet in the frontal region. After the CT scan and laboratory
findings had evidenced a probable infection of the graft, the patient was treated
by vancomycin and cefepime before he underwent surgical revision of its former
CP, with the removal of the graft and the debridement of the surgical field.
Subsequent bacteriological tests revealed Staphylococcus aureus as causal agent
of that infection. CONCLUSION: This case illustrates an anecdotal example of very
late CP infection, due to an unpredictable accident. Due to lack of consensus on
risk factors and on conservative or surgical strategy in case of graft infection,
we aimed to share our surgical experience.