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Reinsertion Versus Replacement for Contaminated or Postoperatively Infected Bone Flaps: Findings From the Largest
Asfand Baig Mirza1, Pak Yin Lam2,3, Sara Ahmad1
1Department of Neurosurgery, Queens Hospital, Romford, UK.
Neurosurgery
|May 4, 2026
Summary
Managing contaminated or infected bone flaps after cranial surgery: preserving flaps with decontamination has higher reoperation risk than replacement for post-operative infections. Selective preservation is advised.
Area of Science:
- Neurosurgery
- Surgical Complications
- Biomaterials
Background:
- Bone flap contamination/infection is a significant risk in cranial surgery.
- Optimal management strategies for compromised bone flaps remain debated.
- This review synthesizes evidence on bone flap preservation versus replacement.
Purpose of the Study:
- To compare outcomes of bone flap decontamination and reinsertion versus discard and replacement.
- To analyze management strategies for intraoperatively contaminated and postoperatively infected bone flaps.
Main Methods:
- Systematic review of 70 studies encompassing 621 patients.
- Data extraction on patient demographics, decontamination protocols, replacement materials, and outcomes.
- Synthesis of individual patient data for comparative analysis.
Main Results:
- Both intraoperative contamination and postoperative infection were analyzed.
- Decontamination methods varied (washing, soaking, autoclaving); replacement materials included titanium, PEEK, etc.
- No infections occurred in intraoperatively contaminated flaps regardless of management.
- Preserved flaps had higher reoperation risk (6.68% AR) for post-operative infections.
- Comorbidities significantly predicted reoperation risk (aOR 44.2).
Conclusions:
- Decontamination and replacement are safe for intraoperative contamination.
- Flap replacement is associated with lower reoperation risk than decontamination for postoperative infections.
- Selective bone flap preservation is recommended, considering infection factors and patient comorbidities.
- Findings support developing risk-stratified guidelines for bone flap management.
