Cranioplasty Using Autoclaved Autologous Skull Bone Flaps Preserved at Ambient Temperature

CONTEXT: Decompressive craniectomy followed by cranioplasty (CP) uses autologous craniectomy flaps or synthetic materials like titanium. Sterilization and preservation methods for the autologous bone flaps continue to be the surgeon's choice. AIM: This study aimed to assess the short-term as well as long-term clinical outcomes of CP using autoclaved autologous bone grafts. SETTINGS AND DESIGN: This retrospective observational study was performed on patients admitted in a tertiary care teaching neurosurgery department. PATIENTS AND METHODS: Seventy-two patients who underwent CP with autoclaved autologous skull flaps preserved under ambient conditions with strict aseptic precautions were included in the study. STATISTICAL ANALYSIS USED: Frequencies and percentages of the various characteristics before and after the surgery were tabulated. Continuous variables were summarized as means and standard deviations. RESULTS: The primary CP had a satisfactory clinical outcome in 62 cases (86.11%). Osteomyelitis was observed in four patients (5.56%) nearly 2 months after the surgery. Radiologically significant bone resorption was noted in a single patient (1.39%) after 1 year. Five patients (6.94%) developed bone fragmentation or fracture, and the mean time taken for this was about 36 months. In all these ten cases, secondary CP was successfully done using a prefabricated, patient-specific titanium mesh. CONCLUSIONS: The efficacy and safety of the studied craniectomy flaps used for cranial reconstruction showed a good patient outcome. Further retrospective studies with larger cohorts and prospective case–control studies are essential so as to issue standard guidelines for sterilization and preservation of autologous bone flaps.