The utility of storage of bone flaps in anterior abdominal wall pockets following decompressive craniectomies for severe traumatic brain injuries

Abstract

Background: Decompressive craniectomy is widely practised for intractable raised intracranial pressure. Many methods are available for reconstruction but their use is limited by cost and organisation in developing countries. The simplest and perhaps the most useful is autologous bone. Difficulties arise on how best to store the bone until cranioplasty.
Aim: To examine the difficulties and the utility of storing craniectomy bone flaps temporarily in anterior abdominal wall pockets.
Methods: In this two-institution study, we retrospectively analysed the use of anterior abdominal wall pockets for the storage of autologous bone flap following decompressive craniectomy. Eleven patients from the Hull Royal Infirmary, UK and four from the Memfy's hospital for Neurosurgery, Nigeria met the criteria. Only patients with severe traumatic brain injury with marked intracranial hypertension as shown on computerized tomography and/or intracranial pressure monitoring, who received maximal medical treatment before and after decompressive craniectomy were included.
Result: There was one case of bone flap infection for which titanium cranioplasty was done at 5 months. There was evidence of minimal bone resorption in two patients but this did not pose any difficulties with reconstruction. All patients showed secure and stable healing at follow-up.
Conclusion: Cranioplasty using autologous bone flap is a safe and simple method of achieving cover following decompressive craniectomy. Storage of the bone in the anterior abdominal wall carries little and easily avoided risks that are comparable to the risks from the use of more sophisticated methods but is more cost effective. It is concluded that this is a method highly suited for developing countries.

Keywords: Intracranial hypertension, Decompressive craniectomy, Autologous bone cranioplasty, Subcutaneous abdominal storage