Autologous bone flap cryopreservation [Neurosurgery Wiki]

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====== Autologous bone flap cryopreservation ======


In order to be compliant to the European directives 2004/23/EC, 2006/86/EC and 2015/565/EC the standard protocol in EU now includes obtaining a [[swab culture]] of the extracted [[autologous bone flap]] prior to its [[cryopreservation]]. This screening for microbial [[contamination]] has resulted in positive [[culture]]s of unknown significance. However, the department protocol from  Linköping, Sweden only allows for reimplantation of bone flaps with negative cultures, leading to increased amounts of discarded bone flaps and thus increasing the use of [[custom-made]] [[implant]]s. To address this problem, the authors developed a new method for handling cryopreserved bone flaps including pulsed lavage of the bone flap preceding culture swab
((Melin S, Haase I, Nilsson M, Claesson C, Östholm Balkhed Å, Tobieson L. Cryopreservation of autologous bone flaps following decompressive craniectomy: A new method reduced positive cultures without increase in post-cranioplasty infection rate. Brain Spine. 2022 Jul 22;2:100919. doi: 10.1016/j.bas.2022.100919. PMID: 36248144; PMCID: PMC9560573.)).
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The objectives of a study of Yeap et al. were to assess the [[predictive value]] of [[swab]] [[culture]]s of cryopreserved [[skull flap]]s during [[cranioplasty]] for [[surgical site infection]]s (SSIs).

The authors conducted a [[retrospective]] [[review]] on the consecutive patients who underwent delayed cranioplasties with cryopreserved [[autograft]]s between 2009 and 2017. The results of [[culture]]s obtained from swabs and infected surgical sites were assessed. The [[accuracy]], [[sensitivity]] and specificity of swab cultures for SSIs were evaluated.

The study included 422 patients, categorized into two groups, the 'swab' and 'non-swab' groups, depending on whether swab cultures were implemented during cranioplasties. The overall infection rate was 7.58%. No difference was seen in the infection rates between both groups. There were 18 false-positive and no true-positive swab culture results. All bacteria between swab cultures and SSI cultures were discordant. Meanwhile, there were 19 false-negative swab cultures. The results showed high specificity but low sensitivity for swab cultures to predict SSI occurrence and the pathogens.

Due to low accuracy and sensitivity, swab cultures of cryopreserved [[autograft]]s should not be routinely performed during delayed cranioplasties
((Yeap MC, Chen CC, Chen CT, Liu ZH, Wu CT, Hsieh PC, Lai HY, Wang YC, Chang TW, Lee CC, Liu YT, Huang YC, Wei KC, Tu PH. Predictive Value of Swab Cultures for Cryopreserved Flaps During Delayed Cranioplasties. World Neurosurg. 2021 Oct 2:S1878-8750(21)01464-9. doi: 10.1016/j.wneu.2021.09.111. Epub ahead of print. PMID: 34610447.))

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