Turkish Neurosurgery 2017 , Vol 27 , Num 6
Management of Dropped Skull Flaps
Mohamed AbdelRahman ABDELFATAH1
1Ain-Shams University, Department of Neurosurgery, Cairo, Egypt DOI : 10.5137/1019-5149.JTN.16986-16.1 AIM: Dropping a skull flap on the floor is an uncommon and avoidable mistake in the neurosurgical operating theater. MATERIAL and METHODS: This study retrospectively reviewed all incidents of dropped skull flaps in Ain-Shams University hospitals during a 10-year period to show how to manage this problem and its outcome.

RESULTS: Thirty-one incidents of dropped skull flaps occurred from January 2004 to January 2014 out of more than 10,000 craniotomies. Follow-up period varied from 20 to 44 months. The bone flap was dropped while elevating the bone (n = 16), while drilling the bone on the operating table (n = 5), and during insertion of the bone flap (n = 10). Treatment included re-insertion of the skull flap after soaking it in povidone iodine and antibiotic solution (n = 17) or after autoclaving (n = 11), or discarding the skull flap and replacing it with a mesh cranioplasty in the same operation (n = 3). No bone or wound infection was noted during the follow-up period.

CONCLUSION: Management of dropped skull flap is its prevention. Replacement of the skull flap, after decontamination, is an option that avoids the expense and time of cranioplasty. Keywords : Dropped skull flap, Craniotomy, Autoclave, Cranioplasty, Povidone iodine

Corresponding author : Mohamed AbdelRahman ABDELFATAH, mohamed_abdelrahman@med.asu.edu.eg