Hair-sparing technique using absorbable intradermal barbed suture versus traditional closure methods in supratentorial craniotomies for tumor
Hair-sparing technique using absorbable intradermal barbed suture versus traditional closure methods in supratentorial craniotomies for tumor
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DOI：
10.1007/s00701-020-04239-3
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发表时间：
2020-01-30
影响因子：
2.4
通讯作者：
Ivan, Michael
中科院分区：
文献类型：
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作者：
Luther, Evan;Berry, Katherine;Ivan, Michael
背景近年来，保留毛发技术在颅神经外科中得到了广泛应用，以前的研究表明感染率没有差异，但评价在保留毛发开颅手术中使用的特定闭合技术的数据有限。因此，本研究的目的是评估在保留毛发的幕上肿瘤开颅手术中使用可吸收真皮内带刺缝合线缝合皮肤的手术部位感染率(SSI)和围手术期并发症，以证明其非劣于传统方法。方法对2011~2017年间同一外科医生行幕上开颅手术治疗肿瘤的临床资料进行回顾性分析。比较三组患者的围手术期不良事件和伤口并发症，包括术后感染、伤口裂开或脑脊液漏：(1)剃发开颅术+经皮聚丙烯缝合缝合头皮，(2)保留毛发开颅术+经皮聚丙烯缝合/吻合器缝合头皮，(3)保留毛发开颅术+可吸收皮内带刺缝合头皮。结果263例患者接受了剃发+经皮聚丙烯缝合/吻合器，83例接受了保留头发+经皮聚丙烯缝合/吻合器，100例接受了保留头发+可吸收皮内带刺缝合。总体而言，2.9%的患者经历了围手术期并发症，4.3%的患者发生了伤口并发症。在多变量分析中，使用带刺缝合头皮和保留头发的技术不能预测任何并发症或30天的再入院。此外，可吸收皮内带刺缝合线的总体伤口并发症发生率最低(4%)。结论皮肤内可吸收带刺缝合术是安全的，与传统方法相比，不会导致较高的感染率、再住院率和再手术率。
Background Hair-sparing techniques in cranial neurosurgery have gained traction in recent years and previous studies have shown no difference in infection rates, yet limited data exists evaluating the specific closure techniques utilized during hair-sparing craniotomies. Therefore, it was the intention of this study to evaluate the rate of surgical site infections (SSIs) and perioperative complications associated with using an absorbable intradermal barbed suture for skin closure in hair-sparing supratentorial craniotomies for tumor in order to prove non-inferiority to traditional methods. Methods A retrospective review of supratentorial craniotomies for tumor by a single surgeon from 2011 to 2017 was performed. All perioperative adverse events and wound complications, defined as a postoperative infection, wound dehiscence, or CSF leak, were compared between three different groups: (1) hair shaving craniotomies + transdermal polypropylene suture/staples for scalp closure, (2) hair-sparing craniotomies + transdermal polypropylene suture/staples for scalp closure, and (3) hair-sparing craniotomies + absorbable intradermal barbed suture for scalp closure. Results Two hundred sixty-three patients underwent hair shaving + transdermal polypropylene suture/staples, 83 underwent hair sparing + transdermal polypropylene suture/staples, and 100 underwent hair sparing + absorbable intradermal barbed suture. Overall, 2.9% of patients experienced a perioperative complication and 4.3% developed a wound complication. In multivariable analysis, the use of a barbed suture for scalp closure and hair-sparing techniques was not predictive of any complication or 30-day readmission. Furthermore, the absorbable intradermal barbed suture cohort had the lowest overall rate of wound complications (4%). Conclusions Hair-sparing techniques using absorbable intradermal barbed suture for scalp closure are safe and do not result in higher rates of infection, readmission, or reoperation when compared with traditional methods.