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CC BY 4.0 · Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1806942
Original Article

Retrospective Study on Complications of Abdominal Subcutaneous Bone Flap Preservation among Patients Undergoing Cranioplasty following Decompressive Craniectomy and Literature Review

Vijayan Peettakkandy
1   Department of Neurosurgery, Government Medical College, Thrissur, Kerala, India
,
Ranjith C. G.
1   Department of Neurosurgery, Government Medical College, Thrissur, Kerala, India
,
Lijo J. Kollannur
1   Department of Neurosurgery, Government Medical College, Thrissur, Kerala, India
,
Biju Krishnan R.
1   Department of Neurosurgery, Government Medical College, Thrissur, Kerala, India
,
Ajmal Rahman Kiliyamannil 
1   Department of Neurosurgery, Government Medical College, Thrissur, Kerala, India
,
Dinu M. K.
2   Department of General Surgery, Government Medical College, Elathur, Kozhikkode, Kerala, India
,
Salman Saleem
1   Department of Neurosurgery, Government Medical College, Thrissur, Kerala, India
,
Ashik S.
1   Department of Neurosurgery, Government Medical College, Thrissur, Kerala, India
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Abstract

Background

Following decompressive craniectomy (DC), the excised bone flap can be stored either in vivo (subcutaneously in the abdominal wall or thigh) or extracorporeally (cryopreserved). While bone flap preservation techniques and postcranioplasty outcomes have been extensively studied, complications related to abdominal wall bone flap storage remain underreported. A retrospective study was conducted on 92 patients who underwent DC followed by cranioplasty with subcutaneous abdominal wall bone flap preservation.

Results

The most common abdominal wall complications included psychological concerns (24%), cosmetic concerns (21.7%), pain at the incision site (19.5%), and abdominal wall heaviness (19.5%). Wound infections occurred in 10% of patients, necessitating bone flap removal in two cases. Other complications included difficulty in squatting (20%), breathing difficulty (2%), and wound hematoma (3%).

Discussion

However, abdominal wall complications, including infection, pain, and cosmetic concerns, should be discussed preoperatively with patients and their families. Despite these challenges, abdominal preservation remains an alternative to cryopreservation in neurosurgical centers with limited infrastructure for bone banking.

Conclusion

Abdominal subcutaneous bone flap preservation following DC is associated with a range of complications, though most are manageable with conservative measures. Autologous bone flap storage in the abdominal wall remains a viable option, particularly in high-volume and resource-constrained settings, due to its cost-effectiveness, biocompatibility, and reduced risk of bone resorption compared with cryopreservation. Given its efficacy and cost advantages, it remains a relevant choice in select settings.

Keywords

decompressive craniectomy - cranioplasty - bone flap preservation - abdominal wall complications - in vivo bone storage

Ethical Approval

The study was approved by the Institutional Review Board and Institutional Ethics Committee (IEC No.: IEC/GMCTSR/2024/087).




Publication History

Article published online:
09 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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