Bone Flap Necrosis Due to Low-Grade Infection with Propionibacterium acnes

Malte Ottenhausen; Darius Kalasauskas; Andreas Kramer; Jonathan Neuhoff; Lucas Serrano; Eike Schwandt; Florian Ringel

doi:10.1016/j.wneu.2018.12.055

Bone Flap Necrosis Due to Low-Grade Infection with Propionibacterium acnes

World Neurosurg. 2019 Apr:124:1-3. doi: 10.1016/j.wneu.2018.12.055. Epub 2018 Dec 24.

Authors

Malte Ottenhausen¹, Darius Kalasauskas², Andreas Kramer², Jonathan Neuhoff², Lucas Serrano², Eike Schwandt², Florian Ringel²

Affiliations

¹ Department of Neurological Surgery, University Medical Center Mainz, Mainz, Germany. Electronic address: Malte.Ottenhausen@unimedizin-mainz.de.
² Department of Neurological Surgery, University Medical Center Mainz, Mainz, Germany.

PMID: 30590219
DOI: 10.1016/j.wneu.2018.12.055

Abstract

Background: Osteonecrosis of bone flaps after cranioplasty with autologous cryoconserved bone flaps is a common phenomenon. The exact reason for it remains unknown.

Case description: We present a case of a 67-year-old patient who had a bone flap necrosis after elective craniotomy and underwent secondary cranioplasty. A low-grade infection with Propionibacterium acnes was detected in microbiologic samples from the bone flap as the cause of the lysis. We discuss similarities with aseptic implant loosening and present recent evidence that low-grade infections might be the underlying reason in several cases.

Conclusions: We conclude that low-grade infections play an underestimated role in bone flap necrosis after cranioplasty as well and encourage routine microbiologic sampling (extended culture and polymerase chain reaction) to rule out infection in all similar cases and suggest a routine antibiotic therapy until final microbiologic results.

Keywords: Aseptic; Bone flap necrosis; Cranioplasty; Low-grade infection; Osteonecrosis; Propionibacterium acnes.