Cryopreservation versus subcutaneous preservation of autologous bone flaps for Cranioplasty: Comparison of the surgical site infection and bone resorption rates

• Which storage method results in lower rates of surgical site infection and bone resorption after cranioplasty remains unanswered.
• We examine 110 patients were preserved by subcutaneous pocket and 180 by cryopreservation.
• The rate of surgical site infection was similar for the two storage methods.
• The incidence of bone flap resorption in the cryopreservation was higher.
• Which method yields better results may depend on the individual surgeon’s preference and available equipment.

ObjectiveDecompressive craniectomy is performed to treat malignant brain hypertension. Surgical site infection (SSI) and bone resorption are common complications following cranioplasty, and the storage method that minimizes such complication has yet to be identified.MethodsOver a 10-year period, the details of 290 decompressive craniectomy procedures performed at our trauma and stroke center were recorded. Bone flaps from 110 patients were preserved in subcutaneous pockets (SPs), and 180 were preserved via cryopreservation (CP).ResultsSSIs occurred in 20 cases (18.2%) in the SP group and 20 cases (11.1%) in the CP group (P = 0.129). After dividing each group according to the traumatic brain injury (TBI) etiologies, we found that in the SP group, the SSI rates in the TBI and non-TBI patients were 17.3% and. 20.7% (P = 0.899), respectively, and in the TBI- and non-TBI CP-group patients, the SSI rates were 11.9% and. 9.7% (P = 0.864), respectively. The average decrease in bone flap thicknesses were 1.14 mm in the SP group (n = 34) and 1.89 mm in the CP group (n = 57), and this difference was significant (P = 0.039).ConclusionsIn this series, the SSI rates were similar in the SP and CP groups. There was no significant difference when the patients were grouped by TBI etiology. The incidence of bone flap resorption in the CP group was higher than that in the SP group. However, identifying of the method that yields superior results might depend on the individual surgeon's preference and the available equipment.