• Rosebist Pathrose Kamalabai, Milesh Nagar, Raj Chandran, Sharmad Mohammed Haneefa Suharanbeevi, Rajmohan Bhanu Prabhakar, Anil Peethambaran, Sreejith Mallika Dhanapalan, Sourabh Jain, and Saurabh Sharma.
• Department of Neurosurgery, Government Medical College, Trivandrum, Kerala, India.
• World Neurosurg. 2018 Mar 1; 111: e105-e112.

ObjectiveDural substitutes are used in decompressive craniectomy (DC) to prevent adhesions during subsequent cranioplasty. Current literature attributes them to reduced blood loss and reduction in operative time of cranioplasty. The use of double-layer substitute has rarely been documented. We studied the use of double-layer G-patch as a dural substitute in DC and evaluated its outcome during subsequent cranioplasty with special focus on flap elevation time and blood loss during cranioplasty.MethodsWe performed emergency frontotemporoparietal decompressive craniectomy using a double layer of G-patch as dural substitute. Subsequent cranioplasty was done in these 35 patients. The development of adhesion formation between the tissue layers, amount of blood loss, and flap elevation time were recorded.ResultsDuring the cranioplasty, a clear and smooth plane of dissection was found between the 2 layers of G-patch in all cases. Average flap elevation time was 21.8 minutes, and average time taken for cranioplasty was 124.12 minutes. Average blood loss was 83 mL. None of the patients required re-exploration for infection of bone flap or postoperative bleed.ConclusionsWhile evaluating the use of dural substitute during DC as an adhesion preventive material for subsequent cranioplasty, flap elevation time and blood loss should be taken into account rather than operative time. Double-layer G-patch during DC facilitates subsequent cranioplasty by preventing adhesions between the layers, resulting in easier dissection and reduced blood loss.Copyright © 2017 Elsevier Inc. All rights reserved.

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