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Successful Immediate Reimplantation of Cranial Bone Flaps in the setting of Infection
Christopher S. Zarella, MD1, Sojung Yi, BS2, Chima O. Oluigbo, MD1, Suresh N. Magge, MD1, John S. Myseros, MD1, Robert F. Keating, MD1, Albert K. Oh, MD1, Gary F. Rogers, MD1.
1Children's National Medical Center, Washington, DC, USA, 2George Washington University School of Medicine, Washington, DC, USA.

Background: Treatment of intracranial abscess requires removal of large segments of cranial bone to access the infection. These bone grafts are obligatorily contaminated and, at times, grossly infected with bacteria. While reimplantation of these devitalized bone segments violates common surgical precepts, the practice is not uncommon in the field of pediatric neurosurgery. We report a large series of patients with intracranial abscesses that were successfully managed with replacement of the bone grafts in the setting of infection.
Methods: A retrospective chart review was performed on all pediatric patients undergoing surgical management of intracranial abscess between 1997 and 2014. Patient characteristics, presentation, operative details, and ultimate outcomes were recorded.
Results: There were 38 bone grafts in 28 patients. 32 grafts in 24 patients were returned immediately following the abscess drainage. Of these, 30 grafts (22 patients) healed uneventfully and required no further procedures. Two grafts (2 patients) required removal at a later operation for infection. 6 grafts (5 patients) were banked frozen. Four healed and had no further procedure. Two became infected and were removed. When known, the source was sinusitis (n=20), periorbital cellulitis (n=1), tooth abscess (n=1), meningitis (n=1), and otitis (n=1).
Conclusion: Our series demonstrates that contaminated or infected cranial bone grafts can be successfully replaced either immediately or after being banked with good clinical results. Nearly 90% of flaps removed in the setting of infection were successfully replaced without complication


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