Effectiveness and Safety of Subcutaneous Abdominal Preservation of Autologous Bone Flap after Decompressive Craniectomy: A Prospective Pilot Study

BACKGROUND: The aim was to assess the effectiveness and safety of reconstructing a cranial bone defect after decompressive craniectomy using an autologous bone flap banked in a subcutaneous pocket in the patient's abdominal wall. METHODS: A prospective pilot study was performed on 12 of 15 consecutive patients who had undergone decompressive craniotomy and subsequent autologous bone flap replacement. The bone flap had been stored in the abdominal wall for an average period of 40 days. To assess the safety of this method, we evaluated the infections rate and the need for a surgical revision. Efficacy was evaluated under different points of view: 1) clinical standpoint, as the cosmetic reconstructive result at 6 months after the replacement; 2) imaging point of view, as the extent of residual bony gap detectable on a three-dimensional computed tomography scan as well as the extent of the bone flap revascularization, detected with a three-phase technetium bone scan. All the bone flaps were evaluated to assess their viability by histological investigations. RESULTS: There was no bone flap infection. The only significant complication encountered in two cases was the formation of a collection under the bone flap, which required its removal. CONCLUSIONS: This preliminary and limited experience has led us to believe that the subcutaneous preservation of autologous bone flap is feasible. This method may be a very inexpensive option that preserves the viability of the bone flap, which can be ultimately responsible for the good cosmetic results and the very low infection rate.