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Abdominal Craniectomy Implantation and Thromboembolism Prophylaxis Resulting in Wound Hematoma

Fargen, Kyle M. MD, MPH; Bhasin, Rohit R. MD; Murad, Gregory J. MD

doi: 10.1227/01.NEU.0000371982.19935.21
Complication Avoidance

BACKGROUND: Refractory intracranial hypertension often is treated with craniectomy to prevent herniation and irreversible neurologic decline in those with salvageable brain injuries.

OBJECTIVE: We report 3 cases of iatrogenic abdominal hematoma at the site of craniectomy implantation secondary to abdominal subcutaneous deep vein thrombosis (DVT) prophylaxis.

METHODS: A retrospective chart review of patients with abdominal wound complications after craniectomy and abdominal bone flap implantation at the University of Florida from 2004 to 2008 was performed.

RESULTS: Three patients receiving subcutaneous DVT prophylaxis via abdominal injections developed hematomas at the site of abdominal implantation. The hematomas occurred 17 days, 20 days, and 6 weeks postoperatively. All required urgent hematoma evacuation. All had evidence of needle sticks overlying the implantation site.

CONCLUSION: To reduce the potential risk of wound hematoma, DVT prophylaxis injections should be performed remote to the surgical site in craniectomized patients with abdominal bone flap implantation.

Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida

Reprint requests:, Kyle Michael Fargen, MD, MPH, UF Department of Neurosurgery, Box 100265, Gainesville, FL 32610–0265. E-mail:

Received, May 20, 2009

Accepted, March 5, 2010

Copyright © by the Congress of Neurological Surgeons