Autologous Skull Bone Flap Sterilization after Decompressive Craniectomy: An Update

OBJECTIVE: Preservation of a bone flap is variably performed after decompressive craniectomy. Here, we report new results with ethylene oxide sterilization and new experiences with autogenous bone flaps autoclaved at a high or low temperature. METHODS: We included 45 patients that underwent a decompressive craniectomy. We determined bone flap preservation with ethylene oxide and with high or low temperature autoclave sterilization. RESULTS: The bone flap was repositioned after a mean of 10 weeks in the ethylene oxide group and after 6 weeks in the other sterilization groups. One patient (2%) sustained a bone flap infection, which required removal and subsequent methylmethacrylate cranioplasty. In one child, the bone flap had partially reabsorbed after 12 months. In all other patients, esthetic results were good after an average follow-up of 42 months. At follow-up, computed tomography or magnetic resonance imaging of the bone flap showed preservation of structural features with apparent fusion and revitalization at the bone flap margins. CONCLUSION: We found that ethylene oxide and high or low temperature autoclave bone sterilization techniques were safe, rapid, and inexpensive for the preservation of autologous bone flaps after decompressive craniectomy.