title: Complications of cranioplasty using a bone flap sterilised by autoclaving following decompressive craniectomy.
abstract: BACKGROUND
  Increasing use of decompressive craniectomies has led to a corresponding number of cranioplasties performed to replace the subsequent bone defect created. We aimed to evaluate the morbidity associated with cranioplasty using an autologous bone flap sterilised in an autoclave.
  
  
  METHODS
  We retrospectively analysed data from 149 patients who underwent cranioplasty following decompressive craniectomy during the time period January 1998 to December 2012. Autologous bone flaps were sterilised in an autoclave and stored in a refrigerator at a temperature of 8 degrees above zero until cranioplasty was performed. Complications were registered and patient data were analysed in order to identify risk factors for surgical site infection and bone flap resorption after cranioplasty. Only the patients with a follow-up period of >24 months were included in the analysis of bone flap resorption (110 patients).
  
  
  RESULTS
  Surgical side infection occurred in only five patients (3.3%), whereas bone flap resorption developed in 22 patients (20%). The multivariate analysis of the presented data identified the operating time of >120 min (p = 0.0277; OR, 16.877; 95% CI, 1.364-208.906) and the presence of diabetes mellitus (p = 0.0016; OR, 54.261; 95% CI, 4.529-650.083) as independent risk factors of development of infection and the presence of ventriculo-peritoneal (VP) shunt (p < 0.0001; OR, 35.564; 95% CI, 9.962-126.960) as independent risk factor of development of the bone flap resorption.
  
  
  CONCLUSIONS
  Reimplantation of the autoclaved autologous bone flap following decompressive craniectomy is a simple and cheep alternative to other techniques and is available to any institution that provides autoclaving sterilisation services. This method is associated with a low rate of surgical site infection, but with a significant rate of the bone flap resorption.
authors.affiliation: Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University in Prague, Faculty Hospital Pilsen, Alej Svobody 80, Pilsen, 304 60, Czech Republic, mracek@fnplzen.cz.
authors.forename: Jan
authors.initials: J
authors.lastname: Mracek
authors.forename: Jolana
authors.initials: J
authors.lastname: Hommerova
authors.forename: Jan
authors.initials: J
authors.lastname: Mork
authors.forename: Patrik
authors.initials: P
authors.lastname: Richtr
authors.forename: Vladimir
authors.initials: V
authors.lastname: Priban
mesh_terms: D000368:Aged; D056424:Decompressive Craniectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013242:Sterilization / Q000379:methods*; D013524:Surgical Flaps / Q000382:microbiology*; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*