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Di Rienzo A, Colasanti R. In Reply to the Letter to the Editor Regarding "Bone Flap Resorption After Cranioplasty: Risk Factors and Proposal of the Flap Integrity Score". World Neurosurg 2024; 185:480-482. [PMID: 38741315 DOI: 10.1016/j.wneu.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Alessandro Di Rienzo
- Department of Neurosurgery, Azienda Ospedali Riuniti Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Roberto Colasanti
- Department of Neurosurgery, Azienda Ospedali Riuniti Ancona, Università Politecnica delle Marche, Ancona, Italy; Department of Neurosurgery, Maurizio Bufalini Hospital, Cesena, Italy.
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2
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Roblot P, Belaroussi Y, Peiffer-Smadja N, Lafarge X, Cotto E, Colombat M, Blohorn L, Gardere M, Kerdiles G, Le Petit L, Wavasseur T, Liguoro D, Jecko V, Vignes JR. Effect of microorganisms isolated by preoperative osseous sampling on surgical site infection after autologous cranioplasty: A single-center experience. Neurochirurgie 2023; 69:101458. [PMID: 37301131 DOI: 10.1016/j.neuchi.2023.101458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/25/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE The most frequent postoperative complication in autologous cranioplasty (AC) is infection. European recommendations include osseous sampling before cryogenic storage of a bone flap. We evaluated the clinical impact of this sampling. METHODS All patients who underwent decompressive craniectomy (DC) and AC in our center between November 2010 and September 2021 were reviewed. The main outcome was the rate of reoperation for infection of the cranioplasty. We evaluated risk factors for bone flap infection, rate of reoperation for any reason (hematoma, skin erosion, cosmetic request, or bone resorption), and radiological evidence of bone flap resorption. RESULTS A total of 195 patients with a median age of 50 (interquartile range: 38.0-57.0) years underwent DC and AC between 2010 and 2021. Of the 195 bone flaps, 54 (27.7%) had a positive culture, including 48 (88.9%) with Cutibacterium acnes. Of the 14 patients who underwent reoperation for bone flap re-removal for infection, 5 and 9 had positive and negative bacteriological cultures, respectively. Of patients who did not have bone flap infection, 49 and 132 had positive and negative bacteriological cultures, respectively. There were no significant differences between patients with and without positive bacteriological culture of bone flaps in the rates of late bone necrosis and reoperation for bone flap infection. CONCLUSIONS A positive culture of intraoperative osseous sampling during DC is not associated with a higher risk of re-intervention after AC.
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Affiliation(s)
- Paul Roblot
- Neurosurgery Department A, University Hospital of Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux, France; Laboratory of Anatomy, University of Bordeaux, 33000 Bordeaux, France.
| | - Yaniss Belaroussi
- Thoracic Surgery Unit, Haut-Lévêque Hospital, CHU de Bordeaux, Pessac, France
| | - Nathan Peiffer-Smadja
- Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Xavier Lafarge
- Tissue Engineering and Cellular Therapy Laboratory, Etablissement Français du Sang Nouvelle-Aquitaine, place Amélie Raba-Léon, 33076 Bordeaux cedex, France
| | - Emmanuelle Cotto
- Tissue Engineering and Cellular Therapy Laboratory, Etablissement Français du Sang Nouvelle-Aquitaine, place Amélie Raba-Léon, 33076 Bordeaux cedex, France
| | - Marie Colombat
- Tissue Engineering and Cellular Therapy Laboratory, Etablissement Français du Sang Nouvelle-Aquitaine, place Amélie Raba-Léon, 33076 Bordeaux cedex, France
| | - Lucas Blohorn
- Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Maxime Gardere
- Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Gaëlle Kerdiles
- Neurosurgery Department A, University Hospital of Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Laetitia Le Petit
- Neurosurgery Department A, University Hospital of Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux, France
| | - Thomas Wavasseur
- Neurosurgery Department A, University Hospital of Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux, France
| | - Dominique Liguoro
- Neurosurgery Department A, University Hospital of Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux, France; Laboratory of Anatomy, University of Bordeaux, 33000 Bordeaux, France
| | - Vincent Jecko
- Neurosurgery Department A, University Hospital of Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux, France; Tissue Engineering and Cellular Therapy Laboratory, Etablissement Français du Sang Nouvelle-Aquitaine, place Amélie Raba-Léon, 33076 Bordeaux cedex, France
| | - Jean-Rodolphe Vignes
- Neurosurgery Department A, University Hospital of Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France; University of Bordeaux, CNRS UMR 5287, INCIA, Zone nord, bâtiment 2, 2(e) étage, 146, rue Léo Saignat, 33076 Bordeaux cedex, France
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3
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Agrawal R, Rompf C, Pranada AB, Vollmar P, De Lorenzo A, Hoyer A, Gousias K. Microbiological profile and infection potential of different cryopreserved skull flaps after decompressive hemicraniectomy. Is cryopreservation at - 80 ℃ better? BMC Res Notes 2022; 15:167. [PMID: 35562808 PMCID: PMC9103457 DOI: 10.1186/s13104-022-06042-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/20/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Patterns of cryopreservation of explanted skull bone flaps have long been a matter of debate, in particular the appropriate temperature of storage. To the best of our knowledge no study to date has compared the microbiological profile and the infection potential of skull bone flaps cryostored at the same institution at disparate degrees for neurosurgical purposes. In the context of our clinical trial DRKS00023283, we performed a bacterial culture of explanted skull bone flaps, which were cryopreserved lege artis at a temperature of either - 23 °C or - 80 °C after a decompressive hemicraniectomy. In a further step, we contaminated the bone fragments in a s uspension with specific pathogens (S. aureus, S. epidermidis and C. acnes, Colony forming unit CFU 103/ml) over 24 h and conducted a second culture. RESULTS A total of 17 cryopreserved skull flaps (8: - 23 °C; 9: - 80 °C) explanted during decompressive hemicraniectomies performed between 2019 and 2020 as well as 2 computer-aided-designed skulls (1 vancomycin-soaked) were analyzed. Median duration of cryopreservation was 10.5 months (2-17 months). No microorganisms were detected at the normal bacterial culture. After active contamination of our skull flaps, all samples showed similar bacterial growth of above-mentioned pathogens; thus, our study did not reveal an influence of the storage temperature upon infectious dynamic of the skulls.
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Affiliation(s)
- R. Agrawal
- Department of Neurosurgery, St Marien Academic Hospital Luenen, University of Muenster, KLW St. Paulus Corporation, Altstadtstrasse 23, 44532 Luenen, Germany
- Medical School, Rheinische Friedrich-Wilhelms University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - C. Rompf
- Department of Medical Microbiology, MVZ Dr. Eberhard & Partner Dortmund, Balkenstrasse 17-19, 44137 Dortmund, Germany
| | - A. B. Pranada
- Department of Medical Microbiology, MVZ Dr. Eberhard & Partner Dortmund, Balkenstrasse 17-19, 44137 Dortmund, Germany
| | - P. Vollmar
- Department of Medical Microbiology, MVZ Dr. Eberhard & Partner Dortmund, Balkenstrasse 17-19, 44137 Dortmund, Germany
| | - A. De Lorenzo
- Department of Psychiatry, LVR, University of Essen-Duisburg, Duisburg, Germany
| | - A. Hoyer
- Biostatistics and Medical Biometry, Medical School OWL, Bielefeld University, Universitätsstrasse 25, 33615 Bielefeld, Germany
| | - K. Gousias
- Department of Neurosurgery, St Marien Academic Hospital Luenen, University of Muenster, KLW St. Paulus Corporation, Altstadtstrasse 23, 44532 Luenen, Germany
- Medical School, Westfaelische Wilhelms University of Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
- Medical School, University of Nicosia, 2408 Nicosia, Cyprus
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4
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The utility of routine autologous bone-flap swab cultures in predicting post-cranioplasty infection. Infect Control Hosp Epidemiol 2022; 44:631-637. [PMID: 35510671 DOI: 10.1017/ice.2022.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Objective:
To evaluate the utility of autologous bone-flap swab cultures performed at the time of cranioplasty in predicting postcranioplasty surgical site infection (SSI).
Design:
Retrospective cohort study.
Participants:
Patients undergoing craniectomy (with bone-flap storage in tissue bank), followed by delayed autologous bone-flap replacement cranioplasty between January 1, 2010, and November 30, 2020.
Setting:
Tertiary-care academic hospital.
Methods:
We framed the bone-flap swab culture taken at the time of cranioplasty as a diagnostic test for predicting postcranioplasty SSI. We calculated, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios.
Results:
Among 282 unique eligible cases, 16 (5.6%) developed SSI after cranioplasty. A high percentage of bone-flap swab cultures were positive at the time of craniectomy (66.7%) and cranioplasty (59.5%). Most organisms from bone-flap swab cultures were Cutibacterium acnes or coagulase-negative staphylococci (76%–85%), and most SSI pathogens were methicillin-susceptible Staphylococcus aureus (38%). Bone-flap swab culture had poor sensitivity (0.07; 95% CI, 0.01–0.31), specificity (0.4; 95% CI, 0.34–0.45), and positive likelihood ratio (0.12) for predicting postcranioplasty SSI.
Conclusion:
Overall, autologous bone-flap swab cultures performed at the time of cranioplasty have poor utility in predicting postcranioplasty SSI. Eliminating this low-value practice would result in significant workload reductions and associated healthcare costs.
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5
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Yeap MC, Chen CC, Chen CT, Liu ZH, Wu CT, Hsieh PC, Lai HY, Wang YC, Chang TW, Lee CC, Liu YT, Huang YC, Wei KC, Tu PH. Predictive Value of Swab Cultures for Cryopreserved Flaps During Delayed Cranioplasties. World Neurosurg 2021; 157:e173-e178. [PMID: 34610447 DOI: 10.1016/j.wneu.2021.09.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the predictive value of swab cultures of cryopreserved skull flaps during cranioplasties for surgical site infections (SSIs). METHODS A retrospective review was conducted of consecutive patients who underwent delayed cranioplasties with cryopreserved autografts between 2009 and 2017. The results of cultures obtained from swabs and infected surgical sites were assessed. The accuracy, sensitivity, and specificity of swab cultures for SSIs were evaluated. RESULTS The study included 422 patients categorized into two groups, swab and nonswab, depending on whether swab cultures were implemented during cranioplasties. The overall infection rate was 7.58%. No difference was seen in infection rates between groups. There were 18 false-positive and no true-positive swab culture results. All bacteria between swab cultures and SSI cultures were discordant. Meanwhile, there were 19 false-negative swab cultures. The results showed high specificity but low sensitivity for swab cultures to predict SSI occurrence and the pathogens. CONCLUSIONS Owing to low accuracy and sensitivity, swab cultures of cryopreserved autografts should not be routinely performed during delayed cranioplasties.
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Affiliation(s)
- Mun-Chun Yeap
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Ching-Chang Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Chun-Ting Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Zhuo-Hao Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Chieh-Tsai Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Po-Chuan Hsieh
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Hong-Yi Lai
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Chi Wang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Ting-Wei Chang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Cheng-Chi Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Tse Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Yin-Cheng Huang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Kuo-Chen Wei
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Po-Hsun Tu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.
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Mirabet V, García D, Roca A, Quiroz AR, Antón J, Rodríguez-Cadarso M, Ocete D, Aranda L, Melero A, Guillot AJ, Yagüe N, Guillén I, Botella C. Cranioplasty with Autologous Bone Flaps Cryopreserved with Dimethylsulphoxide: Does Tissue Processing Matter. World Neurosurg 2021; 149:e582-e591. [PMID: 33556597 DOI: 10.1016/j.wneu.2021.01.131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this article was to study the outcome of patients who underwent cranioplasty with cryopreserved autologous bone after decompressive craniectomy. METHODS Data from 74 patients were retrospectively analyzed. They were divided into groups according to the storage time and the age at cranioplasty. To assess the predictive potential for complication, factors were related to successive stages (preoperative, craniectomy, tissue processing, cranioplasty, and postoperative). Cooling and warming rates applied on bone flap were calculated. The ability to inhibit microbial growth was determined exposing bone fragments to a panel of microorganisms. The concentration of antibiotics eluted from the bone was also determined. A bone explant culture method was used to detect living cells in the thawed cranial bone. RESULTS Hydrocephalus was significantly more frequent in pediatric patients (26.7%) than in adults (5.1%). The overall rate of bone flap resorption was 21.6% (43.7% of which required reoperation). Surgical site infection after cranioplasty was detected in 6.8% of patients. There was no correlation between infection as a postoperative complication and previous microbiological-positive culture during processing. The cause of craniectomy did not influence the risk of bone flap contamination. Vancomycin was the only antibiotic detected in the supernatant where the bone was incubated. Outgrowth from bone explants was observed in 36.8% of thawed skulls. An early start of bone flap processing at the tissue bank had a positive effect on cell viability. CONCLUSIONS The outcome after autologous cranioplasty is a multifactorial process, which is modulated by patient-related, surgery-related, and bone-related factors.
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Affiliation(s)
- Vicente Mirabet
- Cell and Tissue Bank, Centro de Transfusión de la Comunidad Valenciana, Valencia, Spain.
| | - Daniel García
- Cell and Tissue Bank, Centro de Transfusión de la Comunidad Valenciana, Valencia, Spain
| | - Amparo Roca
- Cell and Tissue Bank, Centro de Transfusión de la Comunidad Valenciana, Valencia, Spain
| | - Arnold R Quiroz
- Cell and Tissue Bank, Centro de Transfusión de la Comunidad Valenciana, Valencia, Spain
| | - Joan Antón
- Cell and Tissue Bank, Centro de Transfusión de la Comunidad Valenciana, Valencia, Spain
| | | | - Dolores Ocete
- Service of Microbiology, Consorcio Hospital General Universitario, Valencia, Spain
| | - Lucas Aranda
- Service of Microbiology, Consorcio Hospital General Universitario, Valencia, Spain
| | - Ana Melero
- Department of Pharmacy, Pharmaceutical Technology and Parasitology, Universitat de València, Valencia, Spain
| | - Antonio J Guillot
- Department of Pharmacy, Pharmaceutical Technology and Parasitology, Universitat de València, Valencia, Spain
| | - Nuria Yagüe
- Cell and Tissue Bank, Centro de Transfusión de la Comunidad Valenciana, Valencia, Spain
| | - Isabel Guillén
- Department of Pharmacy, Faculty of Health Sciences, Universidad Cardenal Herrera-CEU, Valencia, Spain
| | - Carlos Botella
- Cell and Tissue Bank, Centro de Transfusión de la Comunidad Valenciana, Valencia, Spain
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The storage of skull bone flaps for autologous cranioplasty: literature review. Cell Tissue Bank 2021; 22:355-367. [PMID: 33423107 DOI: 10.1007/s10561-020-09897-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 12/27/2020] [Indexed: 01/10/2023]
Abstract
The use of autologous bone flap for cranioplasty after decompressive craniectomy is a widely used strategy that allows alleviating health expenses. When the patient has recovered from the primary insult, the cranioplasty restores protection and cosmesis, recovering fluid dynamics and improving neurological status. During this time, the bone flap must be stored, but there is a lack of standardization of tissue banking practices for this aim. In this work, we have reviewed the literature on tissue processing and storage practices. Most of the published articles are focused from a strictly clinical and surgical point of view, paying less attention to issues related to tissue manipulation. When bone resorption is avoided and the risk of infection is controlled, the autograft represents the most efficient choice, with the lowest risk of complication. Otherwise, depending on the degree of involvement, the patient may have to undergo new surgery, assuming further risks and higher healthcare costs. Therefore, tissue banks must implement protocols to provide products with the highest possible clinical effectiveness, without compromising safety. With a centralised management of tissue banking practices there may be a more uniform approach, thus facilitating the standardization of procedures and guidelines.
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8
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Ottenhausen M, Kalasauskas D, Kramer A, Neuhoff J, Serrano L, Schwandt E, Ringel F. Bone Flap Necrosis due to Low Grade Infection with Propionibacterium Acnes. World Neurosurg 2018; 124:S1878-8750(18)32878-X. [PMID: 30590219 DOI: 10.1016/j.wneu.2018.12.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
Abstract
Osteonecrosis of bone flaps after cranioplasty with autologeous cryo-conserved bone flaps is a common phenomenon. The exact reason for it remains unknown. We present a case of a 67-year old patient who had a bone flap necrosis after elective craniotomy and underwent secondary cranioplasty. A low-grade infection with Propionibacterium acnes was detected in microbiological samples from the bone flap as cause of the lysis. We discuss similarities with aseptic implant loosening and present recent evidence that low-grade infections might be the underlying reason in several cases. We conclude that low-grade infections play an underestimated role in bone flap necrosis after cranioplasty as well and encourage routine microbiological sampling (extended culture and PCR) to rule out infection in all similar cases and suggest a routine antibiotic therapy until final microbiological results.
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Affiliation(s)
- Malte Ottenhausen
- Department of Neurological Surgery, University Medical Center Mainz, Germany.
| | - Darius Kalasauskas
- Department of Neurological Surgery, University Medical Center Mainz, Germany
| | - Andreas Kramer
- Department of Neurological Surgery, University Medical Center Mainz, Germany
| | - Jonathan Neuhoff
- Department of Neurological Surgery, University Medical Center Mainz, Germany
| | - Lucas Serrano
- Department of Neurological Surgery, University Medical Center Mainz, Germany
| | - Eike Schwandt
- Department of Neurological Surgery, University Medical Center Mainz, Germany
| | - Florian Ringel
- Department of Neurological Surgery, University Medical Center Mainz, Germany
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9
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Fan MC, Wang QL, Sun P, Zhan SH, Guo P, Deng WS, Dong Q. Cryopreservation of Autologous Cranial Bone Flaps for Cranioplasty: A Large Sample Retrospective Study. World Neurosurg 2017; 109:e853-e859. [PMID: 29107719 DOI: 10.1016/j.wneu.2017.10.112] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/17/2017] [Accepted: 10/20/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To clarify the clinical outcomes of cranioplasty with cryopreserved bone flaps and identify risk factors related to bone flap infection and resorption after cranioplasty with cryopreserved bone flaps. METHODS A total of 946 patients (989 bone flaps) underwent decompressive craniectomy and delayed cranioplasty via the use of cryopreserved autogenous cranial bone flaps. Cranial bone flaps were removed during the initial craniectomy and reserved in liquid nitrogen (-196°C) with dimethyl sulfoxide as a cryoprotectant. Cranioplasty subsequently was performed once the brain injury had healed. Data regarding complications and clinical outcomes were recorded and the potential risk factors were analyzed. RESULTS Data from 960 flaps were available for analysis. The overall complication rate was 15.83% (152 of 960). Bone resorption occurred in 42 flaps in 37 patients (4.38%). The bone flaps resorption rate was greater in patients ≤18 years than in patients >18 years (9.38% vs. 3.61%, P < 0.05). Cryopreservation for more than 365 days tended to result in a greater bone resorption rate (6.88% vs. 2.92%, P < 0.01). Skull bone grafts infection occurred in 39 flaps in 34 patients (4.06%). The bone graft infection rate was greater in emergency craniectomy cases (8.81% vs. 2.59%, P < 0.01) and in patients with diabetes (10.53% vs. 3.07%, P < 0.01). CONCLUSIONS Cryopreservation of autologous cranial bone flaps is safe and effective for cranioplasty. Cranioplasty with cryopreserved autologous cranial bone flaps should be performed no more than 1 year after craniectomy. Emergency craniectomy and patients with diabetes require special attention.
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Affiliation(s)
- Ming-Chao Fan
- Neurosurgical Intensive Care Unit, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qiao-Ling Wang
- Community Medical Service Center of Zhenjiang Street, North City District, Qingdao, China
| | - Peng Sun
- Department of Neurosurgery, the Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Shu-Hua Zhan
- Department of Neurosurgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Pin Guo
- Department of Neurosurgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wen-Shuai Deng
- Neurosurgical Intensive Care Unit, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qian Dong
- Department of Pediatric Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China.
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10
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Chan DYC, Mok YT, Lam PK, Tong CSW, Ng SCP, Sun TFD, Poon WS. Cryostored autologous skull bone for cranioplasty? A study on cranial bone flaps' viability and microbial contamination after deep-frozen storage at -80°C. J Clin Neurosci 2017; 42:81-83. [PMID: 28431953 DOI: 10.1016/j.jocn.2017.04.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/03/2017] [Indexed: 11/15/2022]
Abstract
Craniectomy is a life-saving procedure. Subsequent cranioplasty with autologous skull bone has a bone resorption rate from 4% to 22.8% and an infection rate from 3.3% to 26%. There are concerns with their viability and the potential microbial contamination as they were explanted for a long period of time. Eighteen cranial bone flaps stored at Prince of Wales Hospital Skull Bone Bank during the period from June 2011 to March 2016 were identified. Ethics approval was obtained. Bone chips and deep bone swabs were collected for osteoblast culture and microbial culture. Skull Bone Bank was kept at -80°C under strict aseptic technique during the study period. The storage period ranged from 4months to 55months. For the osteoblast culture, all eighteen bone flaps had no viable osteoblast growth. For the bacterial culture, five had positive bacteria growth (27.8%). Three were Pasteurella multocida and two were Methicillin-resistant Staphylococcus aureus. The mean duration of storage of the infected bone flap was 32.9months (±15.1months) versus 19.9months (±17.9months) of those bone flaps with no bacterial growth (p=0.1716). The mean size of the infected versus non-infected bone flaps was 117.7cm2 (±44.96cm2) versus 76.8cm2 (±50.24cm2) respectively (p=0.1318). Although in this study statistical significance was not reached, it was postulated that infected bone flaps tended to be larger in size and had a longer duration of storage. In conclusion, cryostored skull bone flaps beyond four months showed no viable osteoblasts. Bacterial contamination rate of bone flaps was 27.8% in this study.
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Affiliation(s)
- David Yuen Chung Chan
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
| | - Yi Tan Mok
- Operating Theatre, Prince of Wales Hospital, Hong Kong.
| | - Ping Kuen Lam
- Chow Tai Fook - Cheung Yu Tung Surgical Stem Cell Research Centre, The Chinese University of Hong Kong, Hong Kong.
| | - Cindy See Wai Tong
- Chow Tai Fook - Cheung Yu Tung Surgical Stem Cell Research Centre, The Chinese University of Hong Kong, Hong Kong.
| | - Stephanie Chi Ping Ng
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
| | - Tin Fung David Sun
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
| | - Wai Sang Poon
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Chow Tai Fook - Cheung Yu Tung Surgical Stem Cell Research Centre, The Chinese University of Hong Kong, Hong Kong.
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11
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Morton RP, Abecassis IJ, Hanson JF, Barber J, Nerva JD, Emerson SN, Ene CI, Chowdhary MM, Levitt MR, Ko AL, Dellit TH, Chesnut RM. Predictors of infection after 754 cranioplasty operations and the value of intraoperative cultures for cryopreserved bone flaps. J Neurosurg 2016; 125:766-70. [DOI: 10.3171/2015.8.jns151390] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
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 reimplanted 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.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Timothy H. Dellit
- 2Infection Control, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington
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Hall WA. Cranioplasty Infections—Adding Insult to Injury. World Neurosurg 2014; 82:e435-7. [DOI: 10.1016/j.wneu.2013.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 03/06/2013] [Indexed: 10/27/2022]
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