Management of Dropped Skull Flaps.

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.