Bone dust obtained during making burr holes or during craniotomy is usually lost in suction or discarded. In 1997, we discussed the use of bone dust to cover burr hole and bone defects following craniotomy.[1] We also discussed the use of bone dust, bone debris, and small bone pieces obtained during posterior fossa craniotomy for repositioning and reconstruction.[2] The use of bone dust was cosmetically effective and osteogenic. The osteoinductive potential of the bone dust eventually resulted in new bone formation. It has been speculated that the retained growth factors in the bone dust may potentially induce osteoprogenitor cells to proliferate and mineralize to form new bone.[3] Currently, bone dust is used as a versatile reconstruction material. Ready availability and ease of its deployment have made use of bone dust in reconstruction, following bone work, a well-accepted technique.
Bleeding from the bone during craniotomy can be obstinate, and bone wax has been historically used to pack the bleeding hole in the bone and the diploic spaces and control the bleeding. Bone wax is an important constituent in the neurosurgical operation trolley universally. While bone wax continues to enjoy the sole place in controlling bone bleeding, alternative options have never been reported to be as effective. We identified the use of bone dust obtained during drilling a burr hole and making bone cuts as a possible replacement for bone wax. The authors have found bone dust packing to be effective in controlling bone bleeding. As bone dust is always available after craniotomy, particularly following the use of powered drilling systems, it offers a handy and effective option.
Bone dust paste can be effectively plugged into the bone hole to control bleeding from the diploic spaces or other regions of the skull bone. The technique of pressure-plugging of bone holes with bone dust paste is rather straightforward. After plugging the hole with bone dust, a degree of pressure is maintained with cotton pledget for a period. Suturing or fixing of the bone dust paste is unnecessary. Matsumoto discussed the technique of mixing bone dust with fibrin glue to make a “firm” paste that is deployed for reconstruction.[4]
Bone dust paste was identified to be an effective sealant for dural defects. Relatively small or moderate-sized dural defects can be covered by bone dust paste. Such dural reconstruction with bone dust can be a safe, quick, and effective sealant. Bone dust can replace fat graft in its sealant properties.
It was observed that bone dust could also be used to control extradural venous bleeding. Gentle packing of the extradural pace in the region of venous bleeding can effectively control bleeding.
Our observation is that autologous bone dust, bone chips, and bone debris can be effectively used in a variety of manners and must not be discarded during surgery. Ready and free-of-cost availability and easy maneuvering into a paste make it an effective natural material for reconstruction. The physical quality and osteogenic potential of bone dust are significantly superior to artificial products like bone morphogenic proteins. Apart from its use as a reconstruction of bone and dural defects, it can be effectively used to control bone bleeding and bleeding from the extradural spaces.
REFERENCES
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