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Cranioplasty with Subcutaneously Preserved Autologous Bone Grafts

Background: The efficacy of reconstructing a cranial defect with the craniectomy bone graft (bone flap) banked in a subcutaneous pocket of the abdominal wall after emergency decompressive craniotomy was evaluated. Methods: A retrospective study was performed on 53 of 65 consecutive patients who underwent emergency decompressive craniectomy and bone graft placement in the abdominal wall and survived to graft replacement. Clinical outcome after graft replacement was determined by the adequacy of the recovered craniectomy graft to achieve satisfactory reconstruction, the incidence of infection and the need for revisional surgery. Results: Forty-nine of the 53 patients (92 percent) in whom delayed autogenous graft replacement was attempted achieved a satisfactory one-stage reconstruction. In 42 of these 49 patients, autogenous graft replacement alone was performed. In eight patients it was necessary to supplement the graft with alloplastic material to achieve desired contour. One patient who underwent reconstruction with the autogenous bone graft alone, underwent late revision cranioplasty to improve contour. There were three infections. One graft was found infected in the abdominal pocket at retrieval. Two were lost to operative infection after graft replacement. Histology of two stored grafts performed after abdominal pocket retrieval demonstrated a mixture of necrotic and newly formed woven bone. A bone scan performed 1 year after graft replacement showed radionuclide activity of the graft almost identical to that of intact neighboring bone. Conclusions: Subcutaneous storage preserves viability of portions of autogenous bone grafts. Cranioplasty performed with a subcutaneously preserved craniectomy graft has a low revision rate.