Skull bone flap

[gnom]

Just want to share pretty unusual surgeon's decision. So we are doing an I&D of skull wound. Patient had a craniotomy in December. Suture looks pretty nasty and there is puss coming out of the wound. So we opened the skin and washed it out...Surgeon decided to reopen. We set the drill and everything. When he got the bone flap out he initially asked us to soak it in betadine - so we did. But then he suddenly told me and other citculator to flash the the flap in starilizer for 3 minutes. It really sounded OFF to me. My partner circulator is well seasoned neuro nurse. She told me that she had done it in the past once. Anyways we page risk manager and infection control got involved. Resume - he put mesh in and they didn't let him sterilize the bone. After the case I asked him if he did do it before and he said yes and his rational for doing it was that the bone was infected and after about 6-8 months it will regain the same strenght.

So I just wanted to ask if anyone had experienced that kind of situation before and how did you deal with it???

Andrey

[brainnurse]

Hi,

There's nothing wrong with flashing the skull flap...it does get a little soggy, but like the surgeon said, it hardens up in situ after a few months. No more than 3 minutes, though (3&5) I once put one in for 20 minutes thinking longer would be better, and ended up with a pan full of mush! I scrub it clean, wrap it loosely in a blue towel, and put it in a small flash pan.

It's better if infection control doesn't know what's going on in the OR...they don't understand

We used to freeze the flaps in sandwich baggies, when the brain was too swollen to re-attach it. Then a few weeks later, we'd reconstitute it in hot saline, and put it back in. They don't do that anymore, they have better materials now for cranioplasty. Infection control only looked in that freezer once, didn't know what to say, so pretended they didn't know about it from then on.

You should do some literature searches, and write a policy, so if this comes up again, your neurosurgeon won't have to fight about it.

Hope this helps,

Brainnurse

[core0]

Hi,

There's nothing wrong with flashing the skull flap...it does get a little soggy, but like the surgeon said, it hardens up in situ after a few months. No more than 3 minutes, though (3&5) I once put one in for 20 minutes thinking longer would be better, and ended up with a pan full of mush! I scrub it clean, wrap it loosely in a blue towel, and put it in a small flash pan.

It's better if infection control doesn't know what's going on in the OR...they don't understand

We used to freeze the flaps in sandwich baggies, when the brain was too swollen to re-attach it. Then a few weeks later, we'd reconstitute it in hot saline, and put it back in. They don't do that anymore, they have better materials now for cranioplasty. Infection control only looked in that freezer once, didn't know what to say, so pretended they didn't know about it from then on.

You should do some literature searches, and write a policy, so if this comes up again, your neurosurgeon won't have to fight about it.

Hope this helps,

Brainnurse

I agree. The only time that we had this happen was when the skull flap fell on the floor. We were going to flash it but then we looked at it under the scope and there were areas that were suspicious (PT had a meningioma) so we decided to bag it and rebuild. No real reason not to do this. Not any different than freeze dried bone plugs.

David Carpenter, PA-C

[Annony RN]

I agree with David- it's always good to know that you CAN flash the flap in case it falls! We've had to do it. I can handle the flap better between head and table because I know the world won't end if it drops- so I'm much less likely to drop it!

[core0]

I agree with David- it's always good to know that you CAN flash the flap in case it falls! We've had to do it. I can handle the flap better between head and table because I know the world won't end if it drops- so I'm much less likely to drop it!

I don't know, I always handled it like I handle the liver when we take it out of the box. Wrapped in a towel for better grip, cradled close. Look for any entangling objects on the floor. Move slowly and deliberately. Never seen a liver dropped. Never intend to.

David Carpenter, PA-C

[Annony RN]

Well, I can't say I'm casual but the first few times I had a death grip on it and didn't breathe for the- felt like 25 minutes- until it was back in my basin. I'm pretty sure I couln't handle scrubbing transplants! I'm too anxious.