Autosterilization of Contaminated and Devascularized Bone Fragments Through a Subcutaneous Bone Pouch

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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.


Retrospective review of prospectively collected data.


Community-Based Level 1 Trauma Center.


Eight patients were consented for the described technique, and data were collected over an 8-year period.


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.


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.


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.

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