Please can you provide me any standard policy and procedures for sterilizing bone flap because neuro surgeon in our hospital insist that it can be sterile in Autoclave. Please, this is urgent and I am awaiting your answer. Thank you for your consideration and help. Please can you answer me or refer me to whereever you think I can get help or any idea???

Dear Ali,

Steam sterilization of bone is not a recommended praxis. The American Association of Tissue Bank (AATB) recommends irradiation and ethylen oxide to sterilize bone. The Q & A page of the December 2000 AORN journal might be of help to your problem. Go AORN Online: www.aorn.org/journal/2000/dec2kci.htm, you find answers to your question with further detail (No 1.5) and references.

Josy Holdener

Good day Ali,

We are not actually banking any bone at my hospital.

Our Neurosurgeons have two interests relating to cranial cases.

1. Replacing bone fragments that had become contaminated, either directly through trauma, or that have been dropped on a non-sterile surface during the surgical procedure,
2. Replacing a removed bone fragment within seven days of the original surgery.

We clean the fragment of all debris until it is visibly/surgically clean. We refrigerate the fragment if it is not to be re-implanted immediately. The bone fragment (wrapped in 4x4 gauze sponges) is placed inside a doubled plastic/paper peel-down package. The 4x4's absorb the marrow that seeps from the fragment during sterilization. We steam sterilize the fragment at 250 F for 20 minutes in a 'gravity' sterilization cycle. Of course, we monitor the sterilization cycle for all implants more closely than routine sterilization, using Biological Indicators in addition to our other routine monitors. We have not had any patient infections using this technique.

The literature available through MEDLINE has lots of discussion on various (mutually exclusive) techniques to accomplish our goals. The following 3 references support the technique we are using at my hospital.

References:

• An easy and safe method to store and disinfect explanted skull bone
  Acta Neurochirgia 141(5): 525-528, 1999 Schultke
• Crainioplasty with autogenous autoclaved calvarial bone flap in the cases of tumoral invasion
  Acta Neurochirgia 139(10): 970-6, 1997 Vanaclocha
• Autoclaved bone for craniofacial reconstruction: effects of supplementation with bone marrow.....
  Plastic & Reconstructive Surgery 102(3): 792-800, 1998 Zellin

I hope this helps with your search.

Best regards, Pete