Lim Jaims, Bregy Amade, Gibbons Kevin
Neurological Surgery, Buffalo General Medical Center, Buffalo, USA.
Cureus. 2021 Nov 25;13(11):e19891. doi: 10.7759/cureus.19891. eCollection 2021 Nov.
Craniotomy, cranioplasty, and craniofacial procedures may involve reoperation for additional treatment of the primary pathological condition or treatment of complications, requiring removal of previously placed hardware. During removal of the titanium hardware, there is a risk of losing, dropping, or misplacing the titanium screws because of their small size. There are also instances of difficulty disengaging the screw from the screwdriver. We describe the use of a plastic specimen cup in retrieving titanium screws after detaching them from the screwdriver by screwing the screw into the cup, thus rapidly and safely securing and storing screws for collection/discarding or possible reuse. When the empty screwdriver is used to retrieve and unscrew the titanium screw from the cranial flap or the skull bone, a plastic specimen cup should be placed adjacent to the site of screw removal. Once the screw is removed, while it is still fastened to the screwdriver, it is immediately re-screwed and secured onto the base of the plastic specimen cup, which is then placed into a second plastic specimen cup. This method prevents misplacement or dropping of the screw that may otherwise occur when manipulating the screw on or off the screwdriver and avoids perforating the surgeon's glove during handling. We describe the adjunctive use of a plastic specimen cup when removing cranial screws and hardware to rapidly and safely detach the screw and prevent the misplacement, dropping, or loss of screws intraoperatively that results in additional operative time and personnel assistance.
开颅手术、颅骨修补术和颅面手术可能需要再次手术，以对原发性病理状况进行额外治疗或处理并发症，这就需要移除先前植入的硬件。在移除钛制硬件时，由于钛螺钉尺寸小，存在丢失、掉落或误放的风险。也有螺丝刀难以拧下螺钉的情况。我们描述了一种使用塑料标本杯的方法，通过将螺钉拧入杯中，在将钛螺钉从螺丝刀上拧下后取回螺钉，从而快速安全地固定和存储螺钉以便收集/丢弃或可能的再利用。当使用空螺丝刀从颅骨瓣或颅骨上取下并拧下钛螺钉时，应在螺钉取出部位旁边放置一个塑料标本杯。一旦螺钉被取下，在它仍与螺丝刀相连时，立即将其重新拧到塑料标本杯的底部并固定，然后将该标本杯放入第二个塑料标本杯中。这种方法可防止在螺丝刀上装卸螺钉时可能发生的螺钉误放或掉落，并避免在操作过程中刺穿外科医生的手套。我们描述了在移除颅骨螺钉和硬件时辅助使用塑料标本杯，以便快速安全地拧下螺钉，并防止术中螺钉误放、掉落或丢失，否则会导致额外的手术时间和人员协助。
