Cryopreservation of autologous bone flaps following decompressive craniectomy: A new method reduced positive cultures without increase in post-cranioplasty infection rate

Melin, Sofia M.; Haase, Ismene; Nilsson, Martin; Claesson, Carina; Balkhed, Åse Östholm; Tobieson, Lovisa

doi:10.1016/j.bas.2022.100919

Cited by 5 publications

(4 citation statements)

References 35 publications

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“…To date, we miss established protocols regarding the optimal storage of explanted skull aps after DH. (15,19) ABF are kept frozen in various temperatures mainly from − 20° C to -80° C. (19) Our novel nding shows a clear bene t from a storage at -80° C and should be carefully considered for the future management and storage of ABF.…”

Section: Resultsmentioning

confidence: 85%

“…DiscussionCranioplasty, although technically easily feasible, carries an extremely high rate of short term or secondary complications, the most severe of which are surgical site infection as well as aseptic bone necrosis with consequent bone autolysis. (1,4, 6, 8,12,15, 16) Multiple and long-lasting surgeries, severe traumatic brain injury with fragmented skull aps, younger age as well as comorbidities like hydrocephalus have been identi ed as prognosticators for secondary complications after cranioplasty. (…”

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confidence: 99%

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Explanted skull flaps after decompressive hemicraniectomy demonstrate relevant bone avitality. Is their reimplantation worth of the risk?

Gousias,

Stricker,

Hoyer

et al. 2023

Preprint

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Objective Reimplantations of autologous skull flaps after decompressive hemicraniectomies (DH) are associated with dramatic high rates of postoperative bone flap resorption (BFR). In the context of our clinical trial DRKS00023283, we assessed histologically the cell viability of explanted bone flaps in certain periods of time after DH, in order to conclude whether precursors of BRF may be developed during their storage.Methods Skull bone flaps explanted during a DH between 2019 and 2020 for a vascular disease or traumatic brain injury were sterile stored in a freezer at either − 23°C or -80°C. After their thawing process, the skulls have been collected for histological investigations. Parameters of bone metabolism, namely PTH1 and OPG have been analyzed via immunohistochemistry. H&E stain was used to assess the degree of avital bone tissue, whereas the repeated assays were performed after 6 months.Results A total of 17 stored skull flaps (8–23°C; 9–80°C) were analyzed. Median age of our cohort was 70 years; 9 patients (53%) were male. Duration of cryopreservation varied between 2 and 17 months. Relevant degree of bone avitality has been observed in all skull flaps, which has been significantly increased at the repeated evaluation after 6 months (p < 0.001). Preservation at -23°C (p = 0.006) as well as longer time of storage (p < 0.001) have been identified as prognostic factors for higher rates of bone avitality in a linear mixed regression model.Conclusions Our novel finding shows a clear benefit from a storage at -80° C, which should be carefully considered for the future management and storage of explanted skull flaps. Our analysis further revealed a significant degree of bone avitality, a potential precursor of BFR, also in skull flaps stored for several weeks. To this end, we should reconsider whether the reimplantation of autologous skull flaps instead of synthetic skull flaps is still justified.

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Section: Resultsmentioning

confidence: 85%

mentioning

confidence: 99%

Explanted skull flaps after decompressive hemicraniectomy demonstrate relevant bone avitality. Is their reimplantation worth of the risk?

Gousias,

Stricker,

Hoyer

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Cranioplasty, although technically easily feasible, carries an extremely high rate of short term or secondary complications, the most severe of which are surgical site infection as well as aseptic bone necrosis with consequent bone autolysis [ 1 , 4 , 6 , 8 , 12 , 15 , 16 ]. Multiple and long-lasting surgeries, severe traumatic brain injury with fragmented skull flaps, younger age as well as comorbidities like hydrocephalus have been identified as prognosticators for secondary complications after cranioplasty [ 1 , 3 , 4 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…allows for such far reaching conclusions, since it eliminates the selection bias which would be apparent if similar studies had been performed at various institutes at different locations. To date, we lack established protocols regarding the optimal storage of explanted skull flaps after DH [ 15 , 19 ]. ABFs are kept frozen at various temperatures mainly from −20 °C to −80 °C [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Explanted Skull Flaps after Decompressive Hemicraniectomy Demonstrate Relevant Bone Avitality-Is Their Reimplantation Worth the Risk?

Gousias,

Stricker,

Hoyer

et al. 2023

Brain Sciences

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Background: Reimplantations of autologous skull flaps after decompressive hemicraniectomies (DHs) are associated with high rates of postoperative bone flap resorption (BFR). We histologically assessed the cell viability of explanted bone flaps in certain periods of time after DH, in order to conclude whether precursors of BRF may be developed during their storage. Methods: Skull bone flaps explanted during a DH between 2019 and 2020 were stored in a freezer at either −23 °C or −80 °C. After their thawing process, the skulls were collected. Parameters of bone metabolism, namely PTH1 and OPG, were analyzed via immunohistochemistry. H&E stain was used to assess the degree of avital bone tissue, whereas the repeated assays were performed after 6 months. Results: A total of 17 stored skull flaps (8 at −23 °C; 9 at −80 °C) were analyzed. The duration of cryopreservation varied between 2 and 17 months. A relevant degree of bone avitality was observed in all skull flaps, which significantly increased at the repeated evaluation after 6 months (p < 0.001). Preservation at −23 °C (p = 0.006) as well as longer storage times (p < 0.001) were identified as prognostic factors for higher rates of bone avitality in a linear mixed regression model. Conclusions: Our novel finding shows a clear benefit from storage at −80° C, which should be carefully considered for the future management and storage of explanted skull flaps. Our analysis also further revealed a significant degree of bone avitality, a potential precursor of BFR, in skull flaps stored for several weeks. To this end, we should reconsider whether the reimplantation of autologous skull flaps instead of synthetic skull flaps is still justified.

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Analysis of craniectomy bone flaps stored in a neurosurgical cryopreservation freezer: microorganism culture results and reimplantation rates

Donnelly,

Smolar,

Baig

et al. 2023

Acta Neurochir

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Cryopreservation of autologous bone flaps following decompressive craniectomy: A new method reduced positive cultures without increase in post-cranioplasty infection rate

Cited by 5 publications

References 35 publications

Explanted skull flaps after decompressive hemicraniectomy demonstrate relevant bone avitality. Is their reimplantation worth of the risk?

Explanted skull flaps after decompressive hemicraniectomy demonstrate relevant bone avitality. Is their reimplantation worth of the risk?

Explanted Skull Flaps after Decompressive Hemicraniectomy Demonstrate Relevant Bone Avitality-Is Their Reimplantation Worth the Risk?

Analysis of craniectomy bone flaps stored in a neurosurgical cryopreservation freezer: microorganism culture results and reimplantation rates

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