2Department of Neurosurgery, MedStar Georgetown University Hospital, and.
1Georgetown University School of Medicine.
J Neurosurg. 2022 Apr 29;137(6):1831-1838. doi: 10.3171/2022.3.JNS212637. Print 2022 Dec 1.
It has not been well-elucidated whether there are advantages to preserving bone flaps in abdominal subcutaneous (SQ) tissue after decompressive hemicraniectomy (DHC), compared to discarding bone flaps. The authors aimed to compare perioperative outcomes and costs for patients undergoing autologous cranioplasty (AC) after DHC with the bone flap preserved in abdominal SQ tissue, and for patients undergoing synthetic cranioplasty (SC).
A retrospective review was performed of all patients undergoing DHC procedures between January 2017 and July 2021 at two tertiary care institutions. Patients were divided into two groups: those with flaps preserved in SQ tissue (SQ group), and those with the flap discarded (discarded group). Additional analysis was performed between patients undergoing AC versus SC. Primary end points included postoperative and surgical site complications. Secondary endpoints included operative costs, length of stay, and blood loss.
A total of 248 patients who underwent DHC were included in the study, with 155 patients (62.5%) in the SQ group and 93 (37.5%) in the discarded group. Patients in the discarded group were more likely to have a diagnosis of severe TBI (57.0%), while the most prevalent diagnosis in the SQ group was malignant stroke (35.5%, p < 0.05). There were 8 (5.2%) abdominal surgical site infections and 9 (5.8%) abdominal hematomas. The AC group had a significantly higher reoperation rate (23.2% vs 12.9%, p = 0.046), with 11% attributable to abdominal reoperations. The average cost of a reoperation for an abdominal complication was $40,408.75 ± $2273. When comparing the AC group to the SC group after cranioplasty, there were no significant differences in complications or surgical site infections. There were 6 cases of significant bone resorption requiring cement supplementation or discarding of the bone flap. Increased mean operative charges were found for the SC group compared to the AC group ($72,362 vs $59,726, p < 0.001).
Autologous bone flaps may offer a cost-effective option compared to synthetic flaps. However, when preserved in abdominal SQ tissue, they pose the risk of resorption over time as well as abdominal surgical site complications with increased reoperation rates. Further studies and methodologies such as cryopreservation of the bone flap may be beneficial to reduce costs and eliminate complications associated with abdominal SQ storage.
与丢弃骨瓣相比，减压性去骨瓣术后将骨瓣保留在腹部皮下（SQ）组织中是否有优势，这一点尚未得到充分阐明。作者旨在比较减压性去骨瓣术后行自体颅骨修补术（AC）与行人工合成颅骨修补术（SC）患者的围手术期结局和成本。
对 2017 年 1 月至 2021 年 7 月在两家三级护理机构接受减压性去骨瓣术的所有患者进行回顾性研究。患者分为两组：将骨瓣保留在 SQ 组织中的 SQ 组和将骨瓣丢弃的丢弃组。还对行 AC 与 SC 的患者进行了额外的分析。主要终点包括术后和手术部位并发症。次要终点包括手术费用、住院时间和失血量。
共有 248 例患者接受了减压性去骨瓣术，其中 SQ 组 155 例（62.5%），丢弃组 93 例（37.5%）。丢弃组患者更有可能患有严重 TBI（57.0%），而 SQ 组最常见的诊断为恶性卒中（35.5%，p<0.05）。有 8 例（5.2%）腹部手术部位感染和 9 例（5.8%）腹部血肿。AC 组的再次手术率明显更高（23.2% vs 12.9%，p=0.046），其中 11%归因于腹部再次手术。腹部并发症再次手术的平均费用为 40408.75 美元±2273 美元。颅骨成形术后将 AC 组与 SC 组进行比较，两组并发症或手术部位感染无显著差异。有 6 例因严重骨质吸收需要补充水泥或丢弃骨瓣。与 AC 组相比，SC 组的平均手术费用更高（72362 美元 vs 59726 美元，p<0.001）。
与人工合成皮瓣相比，自体骨瓣可能是一种具有成本效益的选择。然而，当保留在腹部 SQ 组织中时，随着时间的推移，它们会出现吸收的风险，以及腹部手术部位并发症导致的再次手术率增加。进一步的研究和方法，如骨瓣的冷冻保存，可能有助于降低成本并消除与腹部 SQ 储存相关的并发症。
