Pus and free bone flaps.
OBJECTIVE
The goal of this investigation is to describe the results of a vigorous attempt to preserve contaminated free bone flaps and avoid the problems associated with the traditional and common practice of discarding the flap, administering a course of antibiotics, and after several months, performing a cranioplasty.


METHODS
Patients with clearly contaminated, free cranial bone flaps, including so-called high risk cases, were treated by meticulous debridement of the surgical bed, scrubbing, soaking, and then replacing the bone flap in its normal position, and administering a course of intravenous antibiotics.


RESULTS
Fourteen patients with contaminated avascular cranial bone flaps were treated using this technique. All bone flaps were able to be preserved. Conclusions Patients with bacteriologically contaminated, free bone flaps can be treated successfully without discarding the flaps. Success is dependent upon aggressive surgical debridement and persistence.
Department of Neurosurgery, University of Colorado Denver School of Medicine, University Hospital and The Children's Hospital, Denver, Colorado, USA.
Lars
L
Widdel
Ken R
KR
Winston
D000293:Adolescent; D000328:Adult; D001414:Bacitracin / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy / Q000379:methods*; D004203:Disinfection / Q000379:methods*; D013354:Empyema, Subdural / Q000382:microbiology / Q000601:surgery*; D020802:Epidural Abscess / Q000382:microbiology / Q000601:surgery*; D005260:Female; D005624:Frontal Bone / Q000382:microbiology* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D009777:Occipital Bone / Q000382:microbiology / Q000601:surgery; D012092:Replantation / Q000379:methods*; D013203:Staphylococcal Infections / Q000382:microbiology / Q000601:surgery; D013290:Streptococcal Infections / Q000382:microbiology / Q000601:surgery; D013492:Suppuration / Q000382:microbiology / Q000601:surgery*; D013701:Temporal Bone / Q000382:microbiology / Q000601:surgery; D055815:Young Adult
D001414:Bacitracin