Assessing the Seromagenicity of Demineralized Bone Matrix Allograft in Cranial Vault Remodeling

Background: Demineralized bone matrix (DBM) is an organic demineralized matrix heavily utilized for filling bone defects in cranial vault reconstruction. Newer products without carriers, which offer improved handling and malleability, are less well characterized. We hypothesized that DBM with and without carrier would have equivalent safety profiles and sought to investigate any difference in pyrogenicity, drainage volume, and hospitalization. Methods: A retrospective cohort study was conducted for patients who received DBM allograft as part of cranioplasty for sagittal craniosynostosis. Cases using DBM with inert carrier were designated group I and those utilizing carrier-free “pure” DBM were designated group II. Primary outcome variables were maximum daily inpatient temperature (T max ), postoperative drain output, and total drain duration. Results: Thirteen patients were included. Demineralized bone matrix with carrier was used in 61.5% of patients (group I) and carrier-free DBM in 38.5% of patients (group II). Twenty-four hours postoperative group I had a mean T max of 37°C (36.6–37.4°C) versus 36.4°C (36.2–36.6°C) for group II ( P =0.02). Mean total postoperative drain output was 437.9 mL (307.5–568.2 mL) for group I compared with 436.3 mL (261.4-611.1 mL) for group II ( P =0.9). The median time until drain removal was POD 3.5 for group I compared with POD 3 for group II ( P =0.05). Admission duration was 4.75 days for group I and 4 days for group II ( P =0.03). Conclusion: Pure demineralized bone matrix allograft in cranial vault reconstruction for sagittal craniosynostosis results in improved handling with similar postoperative drain outputs when compared with DBM with carrier, with both groups remaining afebrile in the postoperative period.