Reuse or replacement of incidentally dropped craniotomy bone flap: An institutional perspective and literature review.

Surgical neurology international Pub Date : 2025-07-25 eCollection Date: 2025-01-01 DOI:10.25259/SNI_517_2025
Adam Marzouq, Muhammad Khalid B Ahmad, Rakan Bokhari, Saleh S Baeesa
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引用次数: 0

Abstract

Background: Incidental dropout of the craniotomy bone flap (ID-CBF) following craniotomy is a rare and unexpected occurrence in neurosurgery. Consequently, there is scant evidence to direct the surgeon on the most effective management of these events. Any strategy must strike a balance between under-treatment, which carries the risk of infection, and overly aggressive sterilization, which may increase the incidence of bone resorption. The objective of this study is to conduct a comprehensive review of our experience and evaluate it within the context of the extant literature.

Methods: A single-center, retrospective study was conducted to review the electronic records pertaining to operative reports of craniotomies. The objective of this study was to identify instances where bone flaps were inadvertently dropped during surgical procedures. In addition, we conducted a comprehensive review of the extant literature pertaining to the management of ID-CBF.

Results: During the study period, our Institutional Review Committee identified three instances of ID-CBF. One case occurred when the bone flap was inadvertently dropped during elevation, and two cases occurred when it was transferred to the scrubbed nurse. In this specific instance, the bone flap was inadvertently dropped to the ground and was subsequently promptly collected for the purpose of sterilization. The bone flaps underwent a meticulous chemical decontamination protocol. This protocol involved successive copious washing with normal saline, followed by immersion in 50% diluted hydrogen peroxide for a 15 min interval. Subsequently, the flaps were immersed in 10% betadine solution for another 15 min. Finally, they were soaked in normal saline containing gentamicin. Following the surgical procedure, the bone flaps were secured using miniplates and screws at the surgical incision. Subsequently, patients underwent a minimum of 2 years of follow-up care. No clinical, laboratory, or imaging evidence of surgical site infection was observed.

Conclusion: Our series and literature review demonstrate that, in the majority of cases, the bone flap can be reused after undergoing chemical sterilization. Patients require meticulous monitoring to identify early or late surgical site infections. Nevertheless, prevention remains the most effective strategy.

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再次使用或替换偶然掉落的开颅骨瓣:一个制度的观点和文献回顾。
背景:开颅术后骨瓣脱落是神经外科中一种罕见且意想不到的现象。因此,指导外科医生如何最有效地处理这些事件的证据很少。任何策略都必须在治疗不足(有感染的风险)和过度积极的消毒(可能增加骨吸收的发生率)之间取得平衡。本研究的目的是对我们的经验进行全面的回顾,并在现有文献的背景下进行评估。方法:采用单中心、回顾性研究方法,回顾有关开颅手术报告的电子记录。本研究的目的是确定在外科手术过程中骨瓣无意中脱落的情况。此外,我们对有关ID-CBF管理的现有文献进行了全面回顾。结果:在研究期间,我们的机构审查委员会确定了3例ID-CBF。一例发生于骨瓣在抬高过程中不慎掉落,另两例发生于骨瓣被转移到擦洗护士处。在本例中,骨瓣不慎掉到地上,随后迅速收集起来进行消毒。骨瓣经过了细致的化学净化处理。该方案包括用生理盐水连续大量洗涤,然后在50%稀释的过氧化氢中浸泡15分钟。随后,皮瓣在10%倍他定溶液中再浸泡15分钟。最后,将它们浸泡在含有庆大霉素的生理盐水中。手术后,在手术切口处使用微型钢板和螺钉固定骨瓣。随后,患者接受了至少2年的随访治疗。没有观察到手术部位感染的临床、实验室或影像学证据。结论:我们的系列和文献综述表明,在大多数情况下,骨瓣在进行化学灭菌后可以重复使用。患者需要仔细监测,以确定早期或晚期手术部位感染。然而,预防仍然是最有效的战略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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