title: Abdominal craniectomy implantation and thromboembolism prophylaxis resulting in wound hematoma.
abstract: BACKGROUND
  Refractory intracranial hypertension often is treated with craniectomy to prevent herniation and irreversible neurologic decline in those with salvageable brain injuries.
  
  
  OBJECTIVE
  We report 3 cases of iatrogenic abdominal hematoma at the site of craniectomy implantation secondary to abdominal subcutaneous deep vein thrombosis (DVT) prophylaxis.
  
  
  METHODS
  A retrospective chart review of patients with abdominal wound complications after craniectomy and abdominal bone flap implantation at the University of Florida from 2004 to 2008 was performed.
  
  
  RESULTS
  Three patients receiving subcutaneous DVT prophylaxis via abdominal injections developed hematomas at the site of abdominal implantation. The hematomas occurred 17 days, 20 days, and 6 weeks postoperatively. All required urgent hematoma evacuation. All had evidence of needle sticks overlying the implantation site.
  
  
  CONCLUSIONS
  To reduce the potential risk of wound hematoma, DVT prophylaxis injections should be performed remote to the surgical site in craniectomized patients with abdominal bone flap implantation.
authors.affiliation: Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida 32610-0265, USA. kyle.fargen@neurosurgery.ufl.edu
authors.forename: Kyle M
authors.initials: KM
authors.lastname: Fargen
authors.forename: Rohit R
authors.initials: RR
authors.lastname: Bhasin
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Murad
mesh_terms: D000007:Abdominal Injuries / Q000209:etiology*; D000063:Accidents, Traffic; D000328:Adult; D002544:Cerebral Infarction / Q000150:complications / Q000601:surgery; D003399:Craniotomy / Q000009:adverse effects*; D019299:Decompression, Surgical; D004343:Drug Implants / Q000009:adverse effects; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006406:Hematoma / Q000139:chemically induced*; D006408:Hematoma, Subdural / Q000150:complications / Q000473:pathology; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000601:surgery; D013524:Surgical Flaps / Q000473:pathology; D013923:Thromboembolism / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000517:prevention & control; D055815:Young Adult
chemical_list: D004343:Drug Implants; D005343:Fibrinolytic Agents; D006493:Heparin