Skull bone flap

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

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