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

Abstract 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. 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%). 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. 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.