We frequently practice this method in cases where brain relaxation could not be achieved intraoperatively. I have only seen 9 or 10 cases who were complicated by high flow CSF leaks through the wound and subsequent wound infection. We had to remove flaps in those cases and reconstruct the dura and skull at a later date. However, in our experience the benefit of achieving a good ICP control outweighs the below 10% risk of wound infection.

I would like the experts opinion regarding this matter and whether it could be practiced at all or not?

#Pratyush: Do you mean loose (floating) cranial (skull bone) flap ?

yes I mean loose floating skull bone with out dural closure- onlay method.

in my hospital we prefer the removal of bone from the skull and duroplasty. Bone remains in the patient's abdomen for 3 to 12 weeks after it is reattached. Infection rates are low and good results. When there is bone loss, methilmetacrilate use of antibiotics-impregnated with 3% of infections.

The principle of Decompresive craniectomy is to gain the more rom as posible. If you leave the bone flap you are losing a lot of rom. We never do duroplasty, only we cover with any dura sustitute, without sututre, but you have to suture very tightly the galea and skin. We never has experinced leak.

I wouldn’t recommend the use of such surgical technique. This could limit the effectiveness of the decompression you’re trying to achieve. Also, the loose cranial flap will latter attach to the craniotomy margin inadequately. In our institution we preserve the bone flap subcutaneously in the abdominal region and perform duroplasty with galea routinely. After the patient has recovered from trauma, the re-implant surgery has low infection risk and offers good cosmetic result.

Thanks to all. Can I get some peer reviewed or well conducted study material on the same?

Here you have a review article from some collegues of mine. It contains some references that you may find usefull. Good reading!

 Joaquim AF, Mattos JP, Chaddad-Neto F, Lopes A, Oliveira E. Bone flap management 

 Rev Neurocienc 2008: in press

Thank you Marenco.

rarely

Dear Dr Philip

Thanks for your response. I would appreciate if you can elaborate on your response.