title: Autologous Skull Bone Flap Sterilization After Decompressive Craniectomy: An Update.
abstract: OBJECTIVE
  To report new results with ethylene oxide sterilization and new experiences with autogenous bone flaps autoclaved at a high or low temperature for preservation of a bone flap after decompressive craniectomy.
  
  
  METHODS
  In 45 patients who underwent a decompressive craniectomy, we determined bone flap preservation with ethylene oxide and with high- or low-temperature autoclave sterilization.
  
  
  RESULTS
  The bone flap was repositioned after a mean of 10 weeks in the ethylene oxide group and after 6 weeks in the other sterilization groups. A bone flap infection developed in 1 patient (2%), which required removal and subsequent methyl methacrylate cranioplasty. In 1 child, the bone flap had partially reabsorbed after 12 months. In all other patients, esthetic results were good after an average follow-up of 42 months. At follow-up, computed tomography or magnetic resonance imaging of the bone flap showed preservation of structural features with apparent fusion and revitalization at the bone flap margins.
  
  
  CONCLUSIONS
  Ethylene oxide and high- or low-temperature autoclave bone sterilization techniques for the preservation of autologous bone flaps after decompressive craniectomy were safe, rapid, and inexpensive.
authors.affiliation: Department of Neurology and Psychiatry, Neurosurgery, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Missori
authors.affiliation: Department of Neurology and Psychiatry, Neurosurgery, "Sapienza" University of Rome, Rome, Italy. Electronic address: danielemarruzzo@yahoo.it.
authors.forename: Daniele
authors.initials: D
authors.lastname: Marruzzo
authors.affiliation: Department of Neurosurgery, "Sapienza" University of Rome, IRCCS Neuromed-Pozzilli, Rome, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Paolini
authors.affiliation: Department of Neurosurgery, University Hospital Center Mother Theresa, Tirana, Albania.
authors.forename: Arsen
authors.initials: A
authors.lastname: Seferi
authors.affiliation: Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Fricia
authors.affiliation: Department of Neurology and Psychiatry, Neurosurgery, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Chiara
authors.affiliation: Department of Neurology and Psychiatry, Neurosurgery, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Palmarini
authors.affiliation: Department of Neurology and Psychiatry, Neurosurgery, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Domenicucci
mesh_terms: D000328:Adult; D002648:Child; D003080:Cold Temperature; D056424:Decompressive Craniectomy / Q000379:methods; D004202:Disinfectants; D005027:Ethylene Oxide; D005260:Female; D005500:Follow-Up Studies; D006358:Hot Temperature; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods; D012886:Skull / Q000000981:diagnostic imaging / Q000601:surgery*; D013242:Sterilization / Q000379:methods*; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous / Q000379:methods; D055815:Young Adult
chemical_list: D004202:Disinfectants; D005027:Ethylene Oxide
keywords: Bone; Cranioplasty; Decompressive craniectomy; Intracranial hypertension; Sterilization