Complications of cranioplasty using a bone flap sterilised by autoclaving following decompressive craniectomy
Abstract
Background. Increasing use of decompressive craniectomies has led to a corresponding number of cranioplasties performed to replace the subsequent bone defect created.
We aimed to evaluate the morbidity associated with cranioplasty using autologous bone flap sterilized in an autoclave. Methods.
We retrospectively analyzed data in 149 patients who underwent cranioplasty following decompressive craniectomy during the time period January 1998 to December 2012. Autologous bone flaps were sterilized in an autoclave and stored in a refrigerator at a temperature of eight degrees above zero until cranioplasty was performed.
Complications were registered and patient data was analyzed in order to identify risk factors for surgical site infection and bone flap resorption after cranioplasty. Only the patients with a follow-up period of > 24 months were included in the analysis of bone flap resorption (110 patients).
Results. Surgical side infection occurred in only five patients (3,3%), whereas bone flap resorption developed in 22 patients (20%).
The multivariate analysis of the presented data identified the operating time > 120 minutes (p=0.0277; OR 16.877; 95% CI 1.364- 208.906) and the presence of DM (p=0.0016; OR 54.261; 95% CI 4.529 - 650.083) as independent risk factors of development of infection and the presence of VP shunt (p<0,0001; OR 35.564; 95% CI 9.962 - 126.960) as independent risk factor of development of the bone flap resorption. Conclusions.
Reimplantation of the autoclaved autologous bone flap following decompressive craniectomy is a simple and cheep alternative to other techniques and is available to any institution that provides autoclaving sterilization services. This method is associated with a low rate of surgical site infection, but with significant rate of the bone flap resorption.