Deep-freeze preservation of cranial bones for future cranioplasty: nine years of experience in Soroka University Medical Center

Grossman, Nili; Shemesh-Jan, H S; Merkin, Vladimir; Gideon, Marianne D.; Cohen, Abraham

doi:10.1007/s10561-006-9032-x

Cited by 59 publications

(22 citation statements)

References 11 publications

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“…In general, re-implantation of the patient' own bone flap is the preferred practice because of a theoretical decreased risk of immunorejection and its efficacy as a substrate for bony re-growth and revascularization [2,7,16,31]. Nevertheless, the autologous bone flap cranioplasty also has the tendency of a high complication rate in pediatric traumatic brain injury patients [24].…”

Section: Discussionmentioning

confidence: 99%

Early cranioplasty vs. late cranioplasty for the treatment of cranial defect: A systematic review

Niu

et al. 2015

Clinical Neurology and Neurosurgery

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Section: Discussionmentioning

confidence: 99%

Early cranioplasty vs. late cranioplasty for the treatment of cranial defect: A systematic review

Niu

et al. 2015

Clinical Neurology and Neurosurgery

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“…Autosensitisation, the loss of vitality due to loss of perfusion and changes in the three-dimensional structure of the bone plate are the most well known biological reactions and risks. Auto-allergic reactions after re-implantation of lyophilized bone specimen will inevitably induce resorption (Grossman et al, 2007). Resorptive processes of various degrees are unavoidable in all the clinical procedures mentioned (Li et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

A treatment algorithm for patients with large skull bone defects and first results

Lethaus¹,

Laak²,

Laeven³

et al. 2011

Journal of Cranio-Maxillofacial Surgery

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“…This relatively common neurosurgical procedure is associated with complication rates of 15%-35%, 4,6,[8][9][10][12][13][14][15][16][17][18][19][20][22][23][24][25][26][27][28][29] with the most frequent complication being postoperative infection. The highest reported clinical infection rate after cranioplasty is 26%.…”

mentioning

confidence: 99%

Predictors of infection after 754 cranioplasty operations and the value of intraoperative cultures for cryopreserved bone flaps

Morton¹,

Abecassis²,

Hanson³

et al. 2016

JNS

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Predictors of infection afterobJective The authors' aim was to report the largest study on predictors of infection after cranioplasty and to assess the predictive value of intraoperative bone flap cultures before cryopreservation. methods They retrospectively examined all cranioplasties performed between March 2004 and November 2014. Throughout this study period, the standard protocol during initial craniectomy was to obtain a culture swab of the extracted autologous bone flap (ABF)-prior to its placement in cytostorage-to screen for microbial contamination. Two consecutive protocols were employed for the use and interpretation of the intraoperative swab culture results: A) From March 2004 through June 2013, any culture-positive ABF (+ABF) was discarded and a custom synthetic prosthesis was implanted at the time of cranioplasty. B) From July 2013 through November 2014, any ABF with a skin flora organism was not discarded. Instead, cryopreservation was maintained and the +ABF was re-implanted after a 10-minute soak in bacitracin irrigation as well as a 3-minute soak in betadine. results Over the 10.75-year period, 754 cranioplasty procedures were performed. The median time from craniectomy to cranioplasty was 123 days. Median follow-up after cranioplasty was 237 days for protocol A and 225 days for protocol B. The overall infection rate after cranioplasty was 6.6% (50 cases) occurring at a median postoperative Day 31. Staphylococcus spp. were involved as the causative organisms in 60% of cases. Culture swabs taken at the time of initial craniectomy were available for 640 ABFs as 114 ABFs were not salvageable. One hundred twenty-six (20%) were culture positive. Eighty-nine +ABFs occurred during protocol A and were discarded in favor of a synthetic prosthesis at the time of cranioplasty, whereas 37 +ABFs occurred under protocol B and were reimplanted at the time of cranioplasty. Cranioplasty material did not affect the postcranioplasty infection rate. There was no significant difference in the infection rate among sterile ABFs (7%), +ABFs (8%), and synthetic prostheses (5.5%; p = 0.425). All 3 +ABF infections under protocol B were caused by organisms that differed from those in the original intraoperative bone culture from the initial craniectomy. A cranioplasty procedure ≤ 14 days after initial craniectomy was the only significant predictor of postcranioplasty infection (p = 0.007, HR 3.62). coNclusioNs Cranioplasty procedures should be performed at least 14 days after initial craniectomy to minimize infection risk. Obtaining intraoperative bone cultures at the time of craniectomy in the absence of clinical infection should be discontinued as the culture results were not a useful predictor of postcranioplasty infection and led to the unnecessary use of synthetic prostheses and increased health care costs.

show abstract

Deep-freeze preservation of cranial bones for future cranioplasty: nine years of experience in Soroka University Medical Center

Abstract: Deep-freeze preservation of autologous bone grafts to reconstruct skull defects after decompressive craniectomy is a useful procedure and has a low revision rate.

Cited by 59 publications

References 11 publications

Early cranioplasty vs. late cranioplasty for the treatment of cranial defect: A systematic review

Early cranioplasty vs. late cranioplasty for the treatment of cranial defect: A systematic review

A treatment algorithm for patients with large skull bone defects and first results

Predictors of infection after 754 cranioplasty operations and the value of intraoperative cultures for cryopreserved bone flaps

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