Cryopreserved bone flaps from decompressive craniectomies: a microbiological analysis

• Published in: Acta neurochirurgica Vol. 166; no. 1; p. 224
• Main Authors: Romagna, Alexander, Eckert, Albert, Scherg, Florian, Rothe, Kathrin, Meier, Michael, Lehmberg, Jens, Blume, Christian, Rezai, Arwin, Griessenauer, Christoph J., Schwartz, Christoph
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 21.05.2024; Springer Nature B.V
• Subjects: Adult; Aged; Bacteria; Bone growth; Bone surgery; Contamination; Cryopreservation; Cryopreservation - methods; Decompressive Craniectomy - adverse effects; Decompressive Craniectomy - methods; Female; Freezing; Humans; Interventional Radiology; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgery; Neurology; Neuroradiology; Neurosurgery; Neurosurgery general; Original Article; Phenoxyethanol; Propionibacterium acnes - isolation & purification; Risk factors; Skull; Surgical Flaps; Surgical Orthopedics; Surgical site infections; Surgical Wound Infection - microbiology; Surgical Wound Infection - prevention & control; Surgical site infection; Cranioplasty; Autologous bone flap; Cryopreservation
• ISSN: 0942-0940; 0001-6268; 0942-0940
• DOI: 10.1007/s00701-024-06119-6

Purpose Surgical site infection (SSI) is a serious complication after cranioplasty. Due to the relatively frequent occurrence of post-cranioplasty SSI, the utility of autologous bone flap swab cultures surrounding cryopreservation as a reliable predictor has been the subject of an ongoing debate. This bicentric study aims to contribute to this topic by conducting an in-depth analysis of bone flaps obtained via decompressive craniectomies. This study had three major aims: assessments of 1) bacterial contamination of bone flaps after decompressive craniotomy, 2) impact of cryoconservation on contamination rates and 3) potential effectiveness of anti-infective treatment to reduce the germ load prior to cranioplasty. Methods Cryopreserved bone flaps from two centers were used. Microbiological cultivations of swabs prior to and after cryopreservation were taken and assessed for aerobic and anaerobic growth over a 14-day incubation period. Additionally, in a subset of bone flaps, swab testing was repeated after thorough rinsing with an anti-infectant (octenidine-phenoxyethanol) followed by saline. Results All 63 bone flaps (patients median age at surgery: 59 years) were obtained via decompressive craniectomies. Swabs done prior to cryopreservation revealed a 54% infection rate with Propionibacterium acnes being the most common microorganism in 65% of those cases. After thorough disinfection of the preserved bone flaps, all but one case showed no bacterial growth in swab testing. Furthermore, no relevant risk factors for bacterial contamination could be identified. Conclusion This retrospective study showed the common presence of bacterial growth in cryopreserved bone flaps before and after freezing. Rinsing with octenidine-phenoxyethanol and saline effectively prevented bacterial growth in a notable percentage of cases, suggesting a potential strategy to reduce contamination. However, persistent bacterial growth in some cases underscores the need for further research to optimize antiseptic measures during autologous cranioplasty.