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Pus and free bone flaps
1Department of Neurosurgery, University of Colorado Denver School of Medicine, University Hospital and The Children's Hospital, Denver, Colorado, USA.
Object:
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.
Insights
This study shows that preserving contaminated cranial bone flaps is possible. Meticulous debridement and antibiotics can successfully save bone flaps, avoiding cranioplasty.
Area of Science:
- Neurosurgery
- Surgical Infection Control
Background:
- Discarding contaminated cranial bone flaps is standard practice.
- Subsequent cranioplasty is often required after flap removal.
Purpose of the Study:
- To describe a method for preserving contaminated free bone flaps.
- To avoid flap removal and subsequent cranioplasty.
Main Methods:
- Meticulous surgical debridement of contaminated bone flaps and surgical bed.
- Scrubbing and soaking of bone flaps.
- Replacement of bone flap and administration of intravenous antibiotics.
Main Results:
- Fourteen patients with contaminated, avascular cranial bone flaps were treated.
- All treated bone flaps were successfully preserved.
- No patients required flap removal or subsequent cranioplasty.
Conclusions:
- Contaminated cranial bone flaps can be successfully preserved.
- Aggressive surgical debridement and antibiotic therapy are key to successful flap preservation.
- This technique avoids flap loss and the need for cranioplasty.
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