Reinsertion Versus Replacement for Contaminated or Postoperatively Infected Bone Flaps: Findings From the Largest Individual-Patient Analysis to Date
Published research co-authored by Mr Gordan Grahovac
This page summarises a peer-reviewed publication co-authored by Mr Gordan Grahovac. The paper reviews the management of bone flaps that are either contaminated during cranial surgery or become infected after surgery.
The aim of this summary is to make the research easier to understand for patients, families and referring clinicians, while linking directly to the original published work.
Research snapshot
Article title: Reinsertion Versus Replacement for Contaminated or Postoperatively Infected Bone Flaps: Findings From the Largest Individual-Patient Analysis to Date
Authors: Asfand Baig Mirza, Pak Yin Lam, Sara Ahmad, Tony Harshan Linton-Jude, Soniya Chauhan, Wajiha Rauf, Feras Fayez, Ariadni Georgiannakis, Amisha Vastani, Gordan Grahovac, Varinder Singh Alg, Taofiq Desmond Sanusi, Babak Arvin, Ahmed-Ramadan Sadek, Jose Pedro Lavrador
Publication year: 2026
PMID: 42080538
DOI: 10.1227/neu.0000000000004060
Study type: Systematic review and individual-patient data analysis
Mr Grahovac’s involvement: Listed author on the publication
Original publication: View the original publication on PubMed
What this paper looked at
Bone flap infection and contamination are recognised complications of cranial surgery. However, the most appropriate way to manage a contaminated or infected bone flap can vary depending on the clinical situation.
This publication reviewed outcomes from studies comparing two broad approaches:
Preserving the bone flap through decontamination and reinsertion
Discarding the bone flap and replacing it with another material
The review included patients whose bone flaps were contaminated during surgery, as well as patients who developed postoperative bone flap infections.
Key points from the publication
The review included 70 studies and 621 patients.
Three studies reported intraoperative contamination from dropped bone flaps, while 67 studies reported postoperative bone flap infections.
The paper reported that both decontamination with reinsertion and replacement could provide satisfactory cosmetic and neurological outcomes in many patients.
However, in patients with postoperatively infected bone flaps, preserving and reinserting the bone flap was associated with a higher risk of reoperation compared with replacement.
The authors also reported that certain patient factors, including radiotherapy, immunosuppression, diabetes and high body mass index, may influence reoperation risk.
Clinical relevance
This research is relevant to the management of complications after cranial surgery.
When a bone flap is contaminated or infected, the surgical team may need to decide whether it can be safely preserved or whether replacement is the more appropriate option.
The findings suggest that reinsertion may be safe in selected situations, particularly where contamination occurs during surgery. However, when a bone flap becomes infected after surgery, a more cautious, risk-stratified approach may be needed.
What this means in context
This publication does not suggest that one approach is right for every patient.
Decisions around bone flap preservation or replacement depend on several factors, including:
Whether the issue is contamination or established infection
The presence and severity of infection
The organism involved
Whether there is purulence
The patient’s general health
Relevant comorbidities
Previous treatment, such as radiotherapy
The patient’s individual surgical risk
Research of this kind helps inform surgical decision-making, guideline development and discussions around patient safety in cranial surgery.
View the original publication
You can view the original peer-reviewed publication through PubMed or via the article DOI.
View the original publication on PubMed
About Mr Gordan Grahovac
Mr Gordan Grahovac is a Consultant Neurosurgeon and Complex Spinal Surgeon in London and Kent with expertise in managing complex spinal and neurosurgical conditions.
His work includes the assessment and treatment of patients with degenerative spinal conditions, spinal cord compression, spinal tumours, complex spinal pathology and conditions requiring specialist neurosurgical input.
His approach focuses on careful diagnosis, appropriate treatment planning and helping patients understand their options clearly.
Important note
This page is for educational purposes only and should not be taken as individual medical advice.
If you are experiencing symptoms after cranial or spinal surgery, or if you have concerns about infection, wound healing, neurological symptoms, weakness, numbness, worsening pain or changes in your recovery, you should seek advice from an appropriately qualified medical specialist.
