1Department of Pediatric Neurosurgery, Children's University Hospital of Basel.
2Department of Neurosurgery, University Hospital of Basel.
J Neurosurg Pediatr. 2022 Sep 30;30(6):624-632. doi: 10.3171/2022.8.PEDS22270. Print 2022 Dec 1.
Wound healing can be challenging in children undergoing spine surgery for neurological conditions due to a high risk of cerebrospinal fluid (CSF) leakage and wound infection. In adults, use of the Dermabond Prineo (DP) skin closure system, which consists of both tissue adhesive glue and a self-adhesive mesh, for wound closure of medium-length surgical incisions has been reported. The aim of this study was to investigate the efficiency and cosmetic outcome of DP for wound closure in extra- and intradural pediatric neurological spine surgery.
In this prospective cohort study, 47 children underwent 50 spine procedures using DP for wound closure between 2018 and 2022 at a single institution. Patient demographic and surgical data were collected. The primary outcome was revision surgery for wound healing disorders, while secondary outcomes were infections, minor wound healing disorders, and both physician and parental satisfaction (parent-reported outcome measures [PROMs]) at last follow-up.
Among 50 spinal (45 intra- and 5 extradural) interventions, 1 patient (2%) underwent revision surgery for a cutaneous CSF fistula and pseudomeningocele. Minor wound healing disorders occurred after 16 surgeries, which did not require surgical wound revision and resolved completely. No allergic reactions to DP or surgical site infections within 30 days were observed. The parents and the medical team described wound care as significantly facilitated since wound dressing changes were not needed. Three families (6.4%) encountered difficulties in wound care, and 46 (97.9%) were satisfied with DP. The cosmetic outcome based on PROMs was excellent, with a mean score of 8 (IQR 2) on a scale from 1 to 10. At long-term follow-up, a mean of 11.3 ± 10.7 months after surgery, physicians rated the cosmetic outcome on the visual analog scale (median score 9, IQR 1) and Hollander scale (median score 6, IQR 1). The outcomes were similar among the different pathologies and age groups and did not differ in patients with and without syndromic malformations.
The application of DP is simple, enables good patient comfort, facilitates both professional and parental wound care, and leads to excellent cosmetic results. DP possibly aids in the reduction of postoperative CSF leakage and infections after pediatric neurological spine surgery.
由于脑脊液（CSF）漏和伤口感染的风险较高，接受神经状况脊柱手术的儿童的伤口愈合可能具有挑战性。在成年人中，已报道使用 Dermabond Prineo（DP）皮肤闭合系统（由组织粘合剂和自粘网组成）闭合中长切口的伤口。本研究旨在探讨 DP 在小儿神经脊柱外科的硬膜外和硬膜内手术中的伤口闭合效率和美容效果。
在这项前瞻性队列研究中，2018 年至 2022 年期间，一家机构对 47 名儿童进行了 50 次脊柱手术，使用 DP 闭合伤口。收集患者的人口统计学和手术数据。主要结局是因伤口愈合障碍而进行的翻修手术，次要结局是感染、轻微伤口愈合障碍以及最后一次随访时医生和家长满意度（家长报告的结果测量指标[PROM]）。
在 50 例脊柱（45 例硬膜内和 5 例硬膜外）干预中，1 例（2%）患者因皮肤性 CSF 瘘和假性脑膜膨出而接受翻修手术。16 例手术后出现轻微伤口愈合障碍，但无需手术伤口修正，且完全愈合。未观察到 DP 过敏反应或 30 天内手术部位感染。家长和医疗团队表示，由于无需更换伤口敷料，伤口护理明显得到简化。有 3 个家庭（6.4%）在伤口护理方面遇到困难，46 个家庭（97.9%）对 DP 满意。根据 PROM 评估，伤口美容效果极好，平均得分为 8（IQR 2），评分范围为 1 到 10。长期随访时，手术 11.3±10.7 个月后，医生使用视觉模拟量表（中位数评分为 9，IQR 1）和霍兰德量表（中位数评分为 6，IQR 1）对美容效果进行评分。不同病理类型和年龄组的结果相似，且有无综合征畸形的患者之间无差异。
DP 的应用简单，能为患者提供良好的舒适度，方便专业人员和家长进行伤口护理，并带来极好的美容效果。DP 可能有助于减少小儿神经脊柱手术后的术后 CSF 漏和感染。
