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Journal of Neurosurgical Sciences 2003 September;47(3):137-9

language: English

Cryopreservation of auto­ge­ne­ous ­bone ­flap in cra­ni­al sur­gi­cal prac­tice: ­what is the ­future? A ­grade B and evi­dence lev­el 4 ­meta-ana­lyt­ic ­study

Zingale A., Albanese V.

Unit of Neurosurgery P.O. Garibaldi, Catania, Italy


Aim. Autogenous ­bone ­flap ade­quate­ly pre­served can be ­used suc­cess­ful­ly for ­repair of iat­ro­gen­ic cra­ni­al ­bone ­defects ­because of its bio­log­i­cal and eco­nom­ic advan­tag­es. The com­mon­ly ­used tech­niques of ­bone pres­er­va­tion are freez­ing at tem­per­a­ture rang­ing ­from –16 to –40 °C or sub­cu­ta­ne­ous pock­et­ing.
Methods. We ­searched on NLM data­base quer­y­ing as sub­ject head­ings “cra­ni­o­plas­ty and autol­o­gous ­bone" and ­found 7 ­papers meet­ing our cri­te­ria. For eve­ry ­series we con­sid­ered the fre­que­ncy of ­bone resorp­tion and infec­tion and per­formed sta­tis­ti­cal anal­y­sis by ­means of con­tin­gen­cy ­tables car­ry­ing out for the χ2 ­test accord­ing to Pearson and con­sid­er­ing to be sta­tis­ti­cal­ly sig­nif­i­cant p(χ2) <0.05 val­ues.
Results. Compared ­series pre­sent­ed no sta­tis­ti­cal­ly sig­nif­i­cant dif­fer­ence ­with ­regard to fre­quen­cy of the com­pli­ca­tions (χ2=6.43 for crit­i­cal val­ue of 11.07 (k-1=5) (P>0.25) and χ2=5.48 for crit­i­cal val­ue of 7.81 (k-1=3) (P>0.10) respec­tive­ly for infec­tion and resorp­tion.
Conclusion. Although we did not ­find any sig­nif­i­ca­tive dif­fer­ence ­among the fre­quen­cies of the com­pli­ca­tions of the ­series, it is our opin­ion ­that freez­ing the ­bone ­flap is pref­er­able to abdom­i­nal pock­et­ing ­because it ­needs no dou­ble sur­gi­cal abdom­i­nal ­time and the ­bone ­flap fro­zen is strong­er to mechan­i­cal load­ing ­than ­fresh ­flap. Cryopreservation of autol­o­gous ­bone ­flap ­should be the stan­dard tech­nique of pres­er­va­tion for ­delayed cra­ni­o­plas­ty but a mul­ti­cen­tric pros­pec­tive ­trial ­is advis­able to ­obtain in ­short ­time sta­tis­ti­cal­ly sig­nif­i­cant ­results focus­ing bet­ter on the ­rate of mar­gi­nal resorp­tion of the ­bone ­flap ­using new cryo­pro­tec­tant solu­tions.

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