Bone Flap Preservation in Abdominal Wall after Decompressive Craniectomy in Head Injury: A Single Institute Experience

Abstract

Objective: The objective of this study is to study factors associated with infection of calvarial bone flap preserved in subcutaneous tissue of abdominal wall after decompressive craniectomy (DC) in head injury. Associated factors include age, sex, nutrition of patient, GCS of patient at time of surgery, vacuum drain placement, type of paramedian abdominal incision, site of decompressive craniectomy and associated comorbid conditions. Method: This is a prospective study carried out in department of neurosurgery, tertiary care centre of southern Rajasthan (India) from July 2016 to December 2018. Total of 66 patient with head injury were enrolled, who underwent DC and bone flap preservation in abdominal wall. Result: Out of 112 patients who underwent DC in this study period 66 were included in this study. Out of 66 patient 7(10.6%) patient develop bone flap infection. Bone flap infection was more in poor nutrition patient, poor GCS (5-8), patient in which vacuum drain was not placed, patient with bifrontal decompressive craniectomy and associated comorbid condition. Conclusion: Bone flap preservation in subcutaneous abdominal wall after DC is safe and efficient. Cranioplasty with autologous bone graft has lower cost, good cosmetic results and is well accepted by patient.