Treatment of Osteomyelitic Bone Following Cranial Vault Reconstruction With Delayed Reimplantation of Sterilized Autologous Bone: A Novel Technique for Cranial Reconstruction in the Pediatric Patient

Abstract

Craniosynostosis, a deformity of the skull caused by premature fusion of ≥1 cranial sutures, is treated surgically via endoscopic approaches or cranial vault remodeling. Postoperative infection is rare. Management of postoperative surgical site infections often involves culture-directed intravenous antibiotics and debridement, with removal of osteomyelitic bone and hardware in refractory cases. Removal of autologous bone in a pediatric patient presents a reconstructive challenge, as alloplastic options are not optimal in a growing child, especially in the setting of infection. Moreover, infants and small children have limited autologous bone options for reconstruction. We present our case of a young child who developed an infectious complication following cranial vault remodeling. The patient's demographic information, clinical presentation and postoperative course, radiologic features, surgical interventions, and treatment outcomes were reviewed. In our case, autologous osteomyelitic bone underwent tissue processing to eradicate the infection and complete skull reconstruction using the patient's own processed autologous bone was performed in a delayed fashion. The patient is now 1 year postoperative with no recurrence of infection. We present this case as a novel technique to eradicate infection in autologous bone, allowing for delayed autologous cranial reconstruction.

Development of Calvarial Bone Osteomyelitis in a Noonan Syndrome Patient Following Fronto-Orbital Advancement of Craniosynostosis: A Novel Technique of Treatment Using Povidone and Hydrogen Peroxide Solutions

“…The patient later was complicated by SSI and calvarial osteomyelitis. Calvarial osteomyelitis requires aggressive and early treatment with culture-guided IV antibiotics and surgery [ 4 , 13 ]. Surgical options for treating osteomyelitis are various and include the following: debridement with the removal of infected bone and tissue, removal of any foreign objects, draining the infected area, autoclaving, and amputation.…”

“…Their technique was to send the autologous bone flap for bone processing and storage, in which ultrasonication of the bone in solutions of detergent, hydrogen peroxide, gentamicin, and isopropanol was done. Then, the bone was packaged and subjected to a low-dose gamma irradiation; after that, the bone was stored in an ultralow freezer until needed for re-implantation [ 4 ]. In our case, we are proposing a new technique as a useful option for treating calvarial bone osteomyelitis following pediatric calvarial reconstruction.…”

“…Infections do occur post-operatively, reaching up to 8%, but their occurrence can be life-threatening. Calvarial bone osteomyelitis is a complicated problem and is challenging for reconstruction [ 1 , 3 , 4 , 5 ]. Given that this is the first report from Saudi Arabia and the necessity of neurosurgeons and plastic surgeons to be aware of how to deal with such a condition, this study aims to present a new surgical approach to manage patients with Noonan syndrome (NS) who developed calvarial bone osteomyelitis and surgical site infection after craniosynostosis correction.…”

Advantages of an Image-Guided Subcranial Technique for Le Fort III Osteotomies for Midface Advancement: A Case Series

“…This surgical approach has associated disadvantages as it exposes these children to the risks of a craniotomy such as increased blood loss, need for blood transfusion, possible bone flap osteomyelitis, bone flap resorption, venous air embolism, and CSF leak. [13][14][15][16][17] In patients with a CSF shunt, CSF leak increases the risk of shunt infection. 18 A technique that avoids a craniotomy while ensuring an accurate, safe osteotomy would be a favorable alternative.…”