Department of Neurosurgery, Kepler University Hospital and Johannes Kepler University Linz, Wagner-Jauregg Weg 15, 4020 Linz and Altenbergerstrasse 69, Linz, 4040, Austria.
Clinical Research Institute für Neurosciences, Faculty of Medicine, Johannes Kepler University Linz, Wagner-Jauregg Weg 15, Linz, 4020, Austria.
Acta Neurochir (Wien). 2024 Oct 29;166(1):432. doi: 10.1007/s00701-024-06328-z.
Although rare, complications like skin dehiscence and necrosis after neurosurgery pose significant challenges by increasing the risk of infections spreading to the epidural, subdural, or intracerebral spaces. This retrospective, single-center study aims to assess the prior clinical courses, neuroplastic repair, and outcomes of patients with skin defects following cranial neurosurgical procedures, and to outline our interdisciplinary reconstructive protocol.
A retrospective analysis was performed on cranial surgeries conducted at the Department of Neurosurgery, spanning from 2017 to 2023. Patients with skin defects requiring the combined expertise of neurosurgery and plastic surgery for effective treatment were included. The sizes of the skin defects were measured using intraoperative photographs analyzed with the freeware ImageJ software, version 2018. All patients provided informed consent for the surgeries. If informed consent was not possible due to neurological deterioration, consent was sought from adult representatives or next of kin except for acute circumstances. All patients admitted to our hospital agree to the pseudonymized use of their medical data and tissue specimens for research purposes in their treatment contract.
A cohort of 24 patients experiencing wound healing complications after neurosurgical procedures underwent a total of 29 interdisciplinary surgeries for the reconstruction of skin, dural, and bone defects. After the neuroplastic surgery, 8 out of 24 patients (33.3%) developed surgical complications, with 6 of these requiring revision surgeries due to persistent cranial infection. In all cases, permanent wound closure was successfully achieved following adherence to the proposed treatment algorithm.
Our study underscores the necessity of an integrated neurosurgical and plastic surgical approach to effectively manage wound healing complications in a single stage surgery. Key interventions include differentiation between necrosis and gaping lesions, alongside precise management of neurosurgical issues like cerebrospinal fluid fistulas and hydrocephalus. Plastic surgical expertise in assessing the possibilities and limitations of both local and free flap surgeries is essential.
尽管罕见，但神经外科手术后出现的皮肤裂开和坏死等并发症会增加感染扩散至硬膜外、硬脑膜下或脑实质间隙的风险，从而带来严重挑战。本回顾性单中心研究旨在评估颅骨神经外科手术后发生皮肤缺损患者的既往临床病程、神经塑性修复和结局，并概述我们的跨学科重建方案。
对 2017 年至 2023 年期间在神经外科进行的颅骨手术进行回顾性分析。纳入需要神经外科和整形外科联合专业知识进行有效治疗的皮肤缺损患者。使用术中照片并结合 ImageJ 软件（2018 版）分析测量皮肤缺损的大小。所有患者均对手术知情同意。如果由于神经功能恶化而无法获得知情同意，则在除急性情况外，向成年代表或近亲征求同意。所有入住我院的患者均同意在其治疗合同中同意将其医疗数据和组织标本匿名用于研究目的。
24 例神经外科手术后出现伤口愈合并发症的患者共接受了 29 次跨学科手术，以重建皮肤、硬脑膜和骨缺损。神经塑性手术后，24 例患者中有 8 例（33.3%）发生手术并发症，其中 6 例因持续性颅感染需要再次手术。在所有情况下，按照提出的治疗算法，均成功实现了永久性伤口闭合。
我们的研究强调了在单次手术中有效管理伤口愈合并发症需要神经外科和整形外科的综合方法。关键干预措施包括区分坏死和裂开病变，以及精确管理神经外科问题，如脑脊液漏和脑积水。评估局部和游离皮瓣手术的可能性和局限性的整形外科专业知识至关重要。
