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SURGERY - BANGKOK TRAD HOSPITAL, THAILAND

INTRODUCTION:

A male with head injury was admitted to Bangkok Trad Hospital on the 26th February 2000, due to motor cycle accident. After series of investigations the surgeon found that the patient was having sub-dural haematoma and removed the identified section of cranium to treat the subdural haematoma. Immediately after removal, the cranium was sent over to Bhumibol Adulyadej Hospital in Bangkok from where it was transfered to the Bangkok Biomaterial Center for processing, irradiation sterilization and deep-freeze storage at -70⁰C. After irradiation and storage of the cranium bone segment for five months, the surgery date for retransplantation was finalized. The BBC went with a team to the Bangkok Trad Hospital for helping in the re-transplantation and documenting the event.

PATIENT DETAILS

Name : Mr. X

Age : 25 years

Occupation : Agro enterprenur

Accident type : Motorcycle

Date of Admission : First time 28th August 1999

Latest, 25th February 2000

SURGERY DETAILS

	Surgeon Name : Dr. Kitttikorn Panitchaskul
	Chief Complain : Severe head trauma
	Diagnosis : Left frontal hemorrhagic contusion and left temperoccipital epiduralhematoma with left cerebral edema.
	Operation details : Retransplantation of irradiated, deep frozen cranium bone with multiple twisted circlage wires fixation.

SURGICAL TECHNIQUE

The patient was placed under general anesthesia in the supine position. Scrubbed with Betadine and the incision area was identified by a marker and injected with 2% Xylocane. Circular incision was performed to separate the skin from the dura surface and dura mater was exposed. The temproal muscles were removed by elevation and dissection technique. Vascularized soft tissues were removed from around the periphery of the host bone using 28 mm curette and 25 no scalpel blade, fully under the hand control. The graft at this moment was opened from the sterile packing and thawing was allowed. Then the inner faces of the graft were cleaned by irrigating it with sterile normal saline water. The autograft was then placed onto the host bed for identifying the host graft seating position. Once the check was assesed and evaluated to be perfect, drilling on the periphery of the host cranium was done with the help of 1.5 mm drill bits. The holes were drilled 2 -3 cm apart and a total of 12 holes were made. The autograft cranium was again palced over the defect and orientation of the holes were marked to identify the spots for drilling holes on the graft. After this the graft was removed and holes were drilled onto the markings with a 1.5 mm drill bit.

The graft was again placed over the defect and the holes on both the host cranium and autograft cranium were locked and tensioned with circlage wires (28 gauge No) all over the circumference. Measurements of the gaps between the host and graft were recorded. They were 1 mm at parietal, 3mm at frontal and 4 mm at saggital surfaces respectively. The scalp flap closure was done and irrigation with saline and cleaning with sterile cotton swabs and suturing was done. Finally the surface was cleaned with antiseptic (betadine) solution, using Fixomoll stretch tapes was done.

The total surgery time was 3 hrs.

FOLLOW-UP

CBC & ESR - Blood test results dated 27/02/2000

Hb (%) 15.7

Hct (%) 4.6

Platelets 196000

ESR 8

N (%) 53

Band None

E (%) 1

B (%) None

L (%) 40

M (%) 5

RBC (%) Normal

Creatine 0.9

Bun 6

Albumin 4.7

CT SCAN Results dated 25.08.1999

Case of (ICH) with hemorrhage contusion at left frontal and (EDH) at left parietal region, S/P wide craniectomy one day ago TF/U. As compared to the previuos study on 22/08/1999, decrease of ICH at left. Parietal and occipital degree of extensive edema is shown as visualization of left lateral ventricle. Two EDHs left, parietal and occipital regions were absent. Pneumocephalus along left cerebral hemisphere is sequelle of surgery.

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