Efficiency of Anti Adhesive Barriers During Decompressive Craniectomy on Later Cranioplasty

Abstract

Background: Cranioplasty after post-injury decompressive craniectomy (DC) has been routinely performed as the second stage of the treatment. We describe the use of a bioresorbable sheet (Orthowrap®) in DC in order to prevent dural adhesion to overlying tissues.

Materials and Methods: A retrospective analysis of 107 consecutive trauma patients who underwent emergent DC (due to subdural hematoma or intractable intracranial hypertension) and subsequent cranioplasty with autologous bone flap were performed. The technique involved unilateral hemicraniectomy and dural graft with pericranial fascia. A bioresorbable sheet (Orthowrap®) was placed between dura and overlying tissues in some patients (Case group) for protection from future adhesion formation. The development of adhesion formation was evaluated during the cranioplasty in terms of operation time and the amount of blood loss and compared between groups.

Results: Sixteen patients were female (14.9%) and 91 were male (85.1%). Cranioplasty was performed after a meantime of 54.5± 49 days following the DC. Comparing the Hb level before and after cranioplasty, the patients who had undergone craniectomy without the use of Orthowrap® had higher Hb drop than case group (2±1.1 vs .1.7±1.1). Regarding the operation duration, less time was spent on cranioplasty of case group (125.4±41.8 vs. 130.6±41.8). However, the difference between these two parameters in case and control group was not statistically significant.

Conclusion: In our study, DC with the use of a bioresorbable sheet (Orthowrap®) did not show statistically significant advantage over the conventional craniectomy in terms of amount of intraoperative bleeding and duration of operation. We think that a limitation to our study was the sample size.