gms | German Medical Science

Objective: Decompressive hemicraniectomy and duroplasty after malignant brain infarction or traumatic brain injury is a common surgical procedure. Usually, preserved bone flaps are reimplanted after resolution of brain swelling. Artificial bone grafts are seldom directly implanted due to the risk of wound healing disorders. While numerous studies deal with decompressive hemicraniectomy, little is known about the encountered problems of bone flap reimplantation. Thus, the aim of the study was to identify surgery-associated complications after bone flap reimplantation.

Methods: We retrospectively analyzed data of patients that underwent decompressive hemicraniectomy and subsequent bone flap reimplantation during the last ten years at our institution. We registered initial clinical grading, outcome and surgery-associated complications. Patients with incomplete data were excluded from the study.

Results: We identified 135 patients, who underwent decompressive hemicraniectomy and subsequent reimplantation. Thirty-one patients (23%) had surgery-associated complications after bone flap reimplantation. Most often, wound healing disorders or aseptic bone necrosis were the underlying cause (90%, n = 28/31). In two cases, an epidural hematoma (6.5%) and in one case a space-occupying hygroma (3.5%) were further surgery-associated complications.

Conclusions: Almost one fourth of the patients that are operated on for bone flap reimplantation after hemicraniectomy suffer from surgery-associated complications. Most often, wound healing disorders as well as aseptic bone necrosis lead to a third operation with the need for artificial bone implantation. These results might raise the question, whether a third operation can be avoided, if an artificial bone is initially chosen for cranioplasty.