Cosmetic results of autologous bone cranioplasty after decompressive craniectomy for traumatic brain injury based on a patient questionnaire

Background: Decompressive craniectomy (DC) after traumatic brain injury (TBI) is a common surgical procedure. Cranioplasty (CP) is undertaken as a routine secondary operation following DC. In neurosurgical trauma centers, patients who require CPs compete with other patients who require emergency neurosurgical intervention and they are not given enough priority. Methods: A retrospective study was conducted of patients who had undergone autologous bone CP after DC for TBI over three years in a 3rd level trauma center in Mexico. All families were administered a questionnaire to assess how the patient judged the cosmetic result of CP. Results: A total of 29 patients agreed to participate in this study. 25 patients (86.2%) were satisfied with the aesthetic result and 4 patients (13.8%) were no satisfied with their CP. 4 cases (13.8%) reported medical complications related to CP. Unsatisfied patients complained most likely about the dented aesthetic look, with a moderate negative correlation between this and cosmetic outcome (ρ = −0.483, P = 0.001). Patient age (ρ = 0.194, P = 0.314) and defect size (ρ = 0.156, P = 0.419) was not related to the assessment of the aesthetic result. A strong negative correlation between postoperative infection and the grade of satisfaction (ρ = −0.710, P = 0.001) was also observed. Conclusions: Based on our results, overall most of the patients were satisfied with their CP with an acceptable complication rate