Objectives: The purpose of this article was to present results of cases using a subcutaneous bone pouch technique and to assess the potential "autosterilization" effect that occurs when these contaminated free bone fragments are placed in nontraumatized tissue.
Design: Retrospective review of prospectively collected data.
Setting: Community-Based Level 1 Trauma Center.
Patients/participants: Eight patients were consented for the described technique, and data were collected over an 8-year period.
Intervention: Placement of fragments into a surgically created subcutaneous pouch in a nontraumatized tissue zone, followed by delayed, cultured, and attempted reimplantation at the initial injury site.
Main outcome measurements: Culture results after extraction of bone fragments from subcutaneous bone pouch and clinical outcomes after reimplantation into initial open fracture site.
Results: All 8 cases undergoing this technique resulted in healing of the subcutaneous bone pouch without signs or symptoms of infection at the time of attempted reimplantation or fragment removal. Four of the 8 cases had successful reimplantation and union at the open fracture site.
Conclusions: Preserving devascularized bone fragments in a subcutaneous pouch in a region of nontraumatized tissue appears to be a safe procedure that allows for an "autosterilization" type of process to occur.
Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.