When the bone flap hits the floor.

Full Abstract

OBJECTIVE: There is no published data in the neurosurgical literature describing the incidence, treatment, or outcome of contaminating a bone flap. We reviewed our departmental experience to determine methods of prevention and assess our treatment strategies. METHODS: We retrospectively reviewed all incidents of dropped bone flaps during a craniotomy at a single medical center during a 16-year period. In addition, a questionnaire was mailed to neurosurgeons in the United States and abroad asking their own experience and method of management. RESULTS: Fourteen incidents of dropped bone flaps occurred during a 16-year period. Follow-up varied from 2 to 176 months. The bone flap was dropped while elevating the bone (n = 4), when handing the bone off the field (n = 4), and during plating (n = 4). The context was unknown in two cases. Management included soaking the flap in betadine and/or antibiotic solution (n = 8), autoclaving (n = 2), or discarding the bone flap and replacing with a mesh cranioplasty (n = 3). The treatment remains unknown in one case. No instances of infection were noted in follow-up. In response to the survey, 66% (33 out of 50) of the polled neurosurgeons had experienced this complication during their practice, and 83% would replace the bone flap after disinfection. CONCLUSION: Dropping a bone flap during neurosurgery remains an uncommon but preventable complication. Treatment options include discarding the bone followed by cranioplasty versus replacing the bone after treatment with antibiotic irrigation, betadine, and/or autoclaving. Replacement after disinfection is an appropriate option for contaminated bone flaps that avoids the expense and time of cranioplasty.

Author information

Author/s: Jankowitz, Brian T (BT); Kondziolka, Douglas S (DS);

Affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.

Journal and publication information

Publication Type: Journal Article

Journal: Neurosurgery (Neurosurgery), published in United States. (Language: eng)

Reference: 2006-Sep; vol 59 (issue 3) : pp 585-90; discussion 585-90

Dates: Created 2006/09/06; Completed 2006/09/28; Revised 2008/02/12;

PMID: 16955041, status: MEDLINE (last retrieved date: 2/18/2009)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Neurosurgery. 2007 Dec;61(6):E1340. (PMID: 18162879)

CommentIn: Neurosurgery. 2007 Jan;60(1):E208; author reply E208. (PMID: 17228233)

External Links for this article
(including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.