Bone flap removal procedure is growing in frequency in neurosurgical practice. Decompressive craniotomy has gained more scientifical evidences of its therapeutical value in post-traumatic brain swelling, in cerebrovascular diseases and in brain edema non - responding to clinical treatment after elective surgeries. Bone flap destination after craniotomy has many possible fates. We present a literature review of bone flap management in neurosurgical practice: technical preservation of bone flaps (under the scalp, in the abdominal wall, frozen), when to remove the bone flap and what to do when it is dropped during the craniotomy or is infected.172133137Movassaghi, K., Ver Halen, J., Ganchi, P., Amin-Hanjani, S., Mesa, J., Yaremchuk, M.J., Cranioplasty with subcutaneously preserved autologous bone grafts (2006) Plast Reconstr Surg, 117 (1), pp. 202-206Hauptli, J., Segantini, P., New tissue preservation method for bone flaps following decompressive craniotomy (1980) Helv Chir Acta, 47 (1-2), pp. 121-124Tybor, K., Fortuniak, J., Komunski, P., Papiez, T., Andrzejak, S., Jaskólski, D., Supplementation of cranial defects by an autologous bone flap stored in the abdominal wall (2005) Neurol Neurochir Pol, 39 (3), pp. 220-224Josan, V.A., Sgouros, S., Walsh, A.R., Dover, M.S., Nishikawa, H., Hockley, A.D., Cranioplasty in children (2005) Childs Nerv Syst, 21 (3), pp. 200-204Flannery, T., McConnell, R.S., Cranioplasty: Why throw the bone flap out? (2001) Br J Neurosurg, 15 (6), pp. 518-520Krishnan, P., Bhattacharyya, A.K., Sil, K., De, R., Bone flap preservation after decompressive craniectomy - experience with 55 cases (2006) Neurol India, 54 (3), pp. 291-292Korfali, E., Aksoy, K., Preservation of craniotomy bone flaps under the scalp (1988) Surg Neurol, 30 (4), pp. 269-272Goel, A., Deogaonkar, M., Subgaleal preservation of calvarial flaps (1995) Surg Neurol, 44 (2), pp. 181-182. , Aug;, discussion 182-3Pasaoglu, A., Kurtsoy, A., Koc, R.K., Kontas, O., Akdemir, H., Öktem, I.S., Cranioplasty with bone flaps preserved under the scalp (1996) Neurosurg Rev, 19 (3), pp. 153-156Iwama, T., Yamada, J., Imai, S., Shinoda, J., Funakoshi, T., Sakai, N., The use of frozen autogenous bone flaps in delayed cranioplasty revisited (2003) Neurosurgery, 52 (3), pp. 591-596Winkler, P.A., Stummer, W., Linke, R., Krishnan, K.G., Tatsch, K., The influence of cranioplasty on postural blood flow regulation, cerebrovascular reserve capacity, and cerebral glucose metabolism (2000) Neurosurg Focus, 8 (1), pp. e9Matsuno, A., Tanaka, H., Iwamuro, H., Takanashi, S., Miyawaki, S., Nakashima, M., Analyses of the factors influencing bone graft infection after delayed cranioplasty (2006) Acta Neurochir (Wien), 148 (5), pp. 535-540Yacubian-Fernandes, A., Laronga, P.R., Coelho, R.A., Ducati, L.G., Silva, M.V., Prototyping as an alternative to cranioplasty using methylmethacrylate: Technical, 62 (3 B), pp. 865-868. , note. Arq Neuropsiquiatr 2004;Chiarini, L., Figurelli, S., Pollastri, G., Torcia, E., Ferrari, F., Albanese, M., Cranioplasty using acrylic material: A new technical procedure (2004) J Craniomaxillofac Surg, 32 (1), pp. 5-9Korinek, A.M., Risk factors for neurosurgical site infections after craniotomy: A prospective multicenter study of 2944 patients. The French Study Group of Neurosurgical Infections, the SEHP, and the C-CLIN Paris-Nord. Service Epidemiologie Hygiene et Prevention (1997) Neurosurgery, 41 (5), pp. 1073-1079Bruce, J.N., Bruce, S.S., Preservation of bone flaps in patients with postcraniotomy infections (2003) J Neurosurg, 98 (6), pp. 1203-1207Auguste, K.I., McDermott, M.W., Salvage of infected craniotomy bone flaps with the wash-in, wash-out indwelling antibiotic irrigation system. Technical note and case series of 12 patients (2006) J Neurosurg, 105 (4), pp. 640-644Jankowitz, B.T., Kondziolka, D.S., When the bone flap hits the floor (2006) Neurosurgery, 59 (3), pp. 585-59
