The neurosurgical wound and factors that can affect cosmetic, functional, and neurological outcomes

Abstract

Surgically accessing pathological lesions located within the central nervous system (CNS) frequently requires creating an incision in cosmetic regions of the head and neck. The biggest factors of surgical success typically tend to focus on the middle portion of the surgery, but a vast majority of surgical complications tend to happen towards the end of a case, during closure of the surgical site incisions. One of the most difficult complications for a surgeon to deal with is having to take a patient back to the operating room for wound breakdowns and, even worse, wound or CNS infections, which can negate all the positive outcomes from the surgery itself. In this paper, we discuss the underlying anatomy, pharmacological considerations, surgical techniques and nutritional needs necessary to help facilitate appropriate wound healing. A successful surgery begins with preoperative planning regarding the placement of the surgical incision, being cognizant of cosmetics, and the effects of possible adjuvant radiation therapy on healing incisions. We need to assess patient's medications and past medical history to make sure we can optimise conditions for proper wound reepithelialisation, such as minimizing the amount of steroids and certain antibiotics. Contrary to harmful medications, it is imperative to optimise nutritional intake with adequate supplementation and vitamin intake. The goals of this paper are to reinforce the mechanisms by which surgical wounds can fail, leading to postoperative complications, and to provide surgeons with the reminder and techniques that can help foster a more successful surgical outcome.

Risk factors for wound healing complications after revascularization for MMD with complete Y-shaped incision

“…Using skin stapler is another risk factor for PWH in our research. Suture helps to disperse the tension across the incision 17 and promotes the healing of the incision. However, there is no comparative study on skin suture methods in craniotomy.…”

Less Invasive Combined Micro- and Endoscopic Neurolysis of Superficial Peroneal Nerve Entrapment: Technical Note

“…When the incision is long, the force on the wound edges is increased because fewer skin portions are attached. 13) As incisions longer than 10 cm are independently predictive of postoperative pain, 14) the wound length must be shortened and the procedure must be less invasive. Because the S-PN course is relatively straight after branching from the common PN, linear decompression with the aid of an endoscope is feasible.…”

A review on wound management strategies in enhanced recovery after craniotomy: An in‐depth analysis of their influence on patient recovery and surgical outcomes

“…1 The efficacy of a craniotomy is significantly influenced by proficient wound management techniques, which not only facilitate a speedier recovery but also reduce the likelihood of complications. [2][3][4] Ongoing efforts have been made to develop techniques for craniotomy-related wound management that enhance healing, decrease the infection rates and improve patient outcomes as a whole. 5,6 The objective of this review article is to analyse the various strategies employed in wound management following cranial puncture, clarifying how they significantly impact patient recovery and surgical results.…”

“…Post‐cranialotomy wound management is an essential component of the recuperation process. The process encompasses not solely the prevention of infection and the promotion of appropriate healing of the scalp incision, but also the surveillance and control of the cranial bone and brain tissue that were manipulated throughout the operation 2,16 . The implementation of efficient wound management practices is critical in order to minimize pain, prevent post‐operative complications and guarantee optimal functional and aesthetic results 17 …”