Dural Graft Sizing: Building the Right Size Mix for a Hospital Shelf

A good dural graft size mix starts from the hospital's own case history: which procedures need a graft, how large the defects usually are, and how each surgeon closes. From that, the distributor and the OR team set par levels for each size so that the right graft is in the room without opening oversized sheets or letting stock expire.

Sizing sounds like a detail, but it shapes cost and surgeon satisfaction more than many buyers expect. A shelf that holds only a large sheet invites trimming and waste. A shelf that holds every size in depth ties up inventory and leaves units to expire. This article sets out a practical method for building the mix with a hospital, using DESU's DURASHEET and DECOLL as the example.

Why does the size mix matter so much?

A dural graft is a single-use sterile implant. Once opened, any unused portion is discarded. That gives size selection a direct cost effect: each time a larger sheet is opened for a small defect, the hospital pays for material it throws away.

The opposite problem is just as real. If a surgeon needs a large graft for a decompressive procedure or a big convexity defect and only small sizes are on the shelf, the team may have to combine pieces or improvise. Neither outcome is good for the surgeon's confidence in the product or for the distributor's reputation.

What information do you need before proposing a mix?

Do not propose a size mix from a brochure. Gather the facts first, ideally with the OR coordinator for neurosurgery and spine.

• The procedures in which grafts are used: cranial tumor resection, posterior fossa decompression, trauma, skull base, spine durotomy and intradural spine cases.
• A recent period of graft usage, by size, from the hospital's usage reports or case records where available.
• Each surgeon's typical technique: suturing, onlay or both.
• How often grafts are trimmed, and from which size.
• Which rooms the grafts are used in, since cranial and spine ORs may be stocked separately.
• The hospital's rules on consignment, owned inventory and expiry management.

If the hospital has no usable data, a short interview with the main surgeons and the charge nurse can fill the gap. Ask them what they reach for and what they wish they had.

It is also worth asking the buyer how dural grafts are currently ordered and received. If grafts arrive through a central warehouse before reaching the OR, the replenishment cycle will be longer than if they are delivered directly to the department, and par levels need to reflect that.

How do you turn that into a size mix?

DESU's DURASHEET and DECOLL each come in four sizes. Check exact dimensions in the current catalog and IFU. The mix then follows two questions: which technique, and how large is the usual defect.

The table is a framework, not a prescription. Defect size varies widely between patients and surgeons, and the hospital's own data should override any general pattern.

How should par levels be set?

Par level is the number of units of each item kept on the shelf, replenished as they are used. For dural grafts, a few principles keep par levels sensible:

• Keep at least one unit of every size the surgeons use, so the right size is always available.
• Hold more depth in the sizes that move fastest, and less in the sizes used occasionally.
• Separate par levels for different locations if the cranial and spine ORs stock separately.
• Account for the replenishment lead time, so that stock does not run out between orders.
• Review expiry dates at every count and rotate stock so the earliest expiry is used first.

Where the hospital uses consignment, agree clearly who counts, who replenishes and how used units are billed. Where the hospital owns the stock, make sure the buyer understands the expiry profile of what they are buying.

Reducing trimming waste

Trimming is normal; surgeons cut grafts to fit irregular defects. Waste becomes a problem when the habit is to open a large sheet by default. Two steps usually help.

First, make sure smaller sizes are stocked where the small cases happen, typically the spine OR. Second, show the OR team the full range of sizes on one card or shelf label, so the circulating nurse can offer the size that fits before opening a package. A quick question from the circulator, such as "Which size would you like?" before the package is opened, often saves more material than any change in the par levels. Our guide to matching dural graft format to the defect covers the clinical side of size choice.

How do consignment and owned stock change the plan?

On consignment, the distributor or manufacturer keeps ownership of the shelf stock until a unit is used. This lets a hospital hold a fuller size range without paying for it up front, but it requires reliable counts, clear replenishment triggers and a process for billing used units. The distributor carries the expiry risk, so rotation and visibility become the distributor's responsibility.

When the hospital buys stock outright, it carries the expiry risk itself. Buyers then tend to prefer a leaner shelf, which makes the choice of sizes more important. In either model, agree in writing who counts, how often, and what happens to units approaching expiry.

What mistakes should you avoid?

• Copying another hospital's size mix without checking the local case mix.
• Stocking only the largest size because it can always be trimmed.
• Forgetting the spine OR when it is stocked separately from the cranial rooms.
• Setting par levels once and never reviewing them.
• Letting expiry dates go unchecked until a unit is found expired in the room.

How do you keep the shelf working over time?

Regular reviews

Review the size mix after the first months of use, then at regular intervals agreed with the hospital. Look at which sizes were used, which expired or came close to expiry, and whether any case had to wait for a size that was not stocked. Adjust par levels accordingly.

A review is also a good moment to talk with surgeons and with the buyer about whether the current arrangement still fits. A new surgeon joining the department, a change in technique or a new service line, such as a trauma program or an endoscopic skull base program, can shift the size pattern quickly.

Labeling and implant records

Dural graft packaging carries the information a hospital needs to manage stock and record implants, such as product identification, size, lot number and expiry date, usually shown with standard symbols. Make sure the OR team knows where to find each one on the DESU label, and that the implant record captures the lot number at the point of use. The article on dural graft traceability and storage explains these elements in more depth.

Talk to a DESU product specialist

If you are planning a dural graft shelf for a hospital or a group of accounts, DESU's product specialists can share the size range and catalog details for DURASHEET and DECOLL, help you think through a size mix and discuss supply for your market. Write to sales@desu.tr, use the contact page, or request a quote.