032. Subcutaneous Storage of Bone Flaps after Decompressive Craniectomy; Infection and Resorption Rates

Authors: Jo Ling Goh, MD

In pediatric patients, reconstruction of cranial defect after decompressive hemicraniectomy with autologous bone flap is advantageous given that significant bone growth is expected. Storage of the bone flap via cryopreservation has been associated with significant bone resorption. At our institution, we primarily store the bone flap via subcutaneous implantation in the patient. Here, we report the outcomes of secondary cranioplasties due to sterile resorption or infection of 89 pediatric patients who underwent decompressive craniectomy followed by autologous cranioplasty.Methods: A retrospective chart review was performed of all patients undergoing decompressive hemicraniectomies at Dallas Children’s Medical Center from 2002 to 2020. Eighty-nine patients were identified ranging in age from 3 months to 17 years. Recorded variables included basic demographic information, indication for decompression, interval to cranioplasty, cranioplasty fixation technique, subsequent infections and treatments, and subsequent reconstructive surgeries.
Seventy three (82%) of patients had their bone preserved in subcutaneous pockets in the anterior abdominal wall. Eleven patients (12%) of patients developed infections. Seven (9.6%) were in the subcutaneous group; two (13%) were in the cryopreserved group. Three of the patients had successful washout and re-implantation of the cranioplasty but four required removal of the bone flap and secondary cranioplasties. Six patients (0.06%) had sterile resorption of their bone flap necessitating secondary cranioplasty; five of the six patients had their bone cryopreserved.
Subcutaneous storage of cranial flap is associated with less clinically sterile resorption after autologous cranioplasty in our series.