Abdominal craniectomy implantation and thromboembolism prophylaxis resulting in wound hematoma

Neurosurgery. 2010 Aug;67(2):495-7. doi: 10.1227/01.NEU.0000371982.19935.21.


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.

Publication types

  • Case Reports

MeSH terms

  • Abdominal Injuries / etiology*
  • Accidents, Traffic
  • Adult
  • Cerebral Infarction / complications
  • Cerebral Infarction / surgery
  • Craniotomy / adverse effects*
  • Decompression, Surgical
  • Drug Implants / adverse effects
  • Fibrinolytic Agents / adverse effects*
  • Fibrinolytic Agents / therapeutic use
  • Hematoma / chemically induced*
  • Hematoma, Subdural / complications
  • Hematoma, Subdural / pathology
  • Heparin / adverse effects
  • Heparin / therapeutic use
  • Humans
  • Iatrogenic Disease
  • Male
  • Middle Aged
  • Paresis / etiology
  • Postoperative Complications / etiology*
  • Retrospective Studies
  • Subarachnoid Hemorrhage / complications
  • Subarachnoid Hemorrhage / surgery
  • Surgical Flaps / pathology
  • Thromboembolism / prevention & control*
  • Venous Thrombosis / prevention & control
  • Young Adult


  • Drug Implants
  • Fibrinolytic Agents
  • Heparin