Wound healing
Wound healing is a complex and dynamic process that involves modifying the wound environment depending on the patient’s health status.
Unaffected wound healing and good cosmetic result after a neurosurgical procedure are important factors measuring a level of care.
In neurosurgical cases, problems related to wound healing can vary from simple wound dehiscence to multilayer defects. A study demonstrates an effective method to prevent persistent cerebrospinal fluid fistula using reinforcing acellular dermal matrix in neurosurgical patients with wound dehiscence 1).
The available published data may suggest a higher risk of wound healing concerns and lower than average bone fusion with disease-modifying antirheumatic drugs, although this may be under-reported given the current state of the literature 2).
Data suggest that surgical site infection and wound dehiscence are significantly reduced with the addition of incisional negative pressure wound therapy in degenerative spine disease and trauma setting 3).
During a one-year microneurosurgical fellowship, a wound closure under the microscope in 200 of 524 neurosurgical operations at the Department of Neurosurgery, Helsinki University Central Hospital. Supratentorial approaches were employed most frequently in 143 patients (72%). Surgeries for infratentorial lesions and the spinal canal comprised 48 (24%) and 9 procedures (4%), respectively. Mean duration of the surgery from skin to skin was 1.8 (range 0.5-6.2) hours. After intradural hemostasis was completed by the senior author, further steps including dural suturing, bone flap fixation, and wound closure were performed by the first author. Wound condition was assessed during the early and late postoperative period. Mean follow-up was 3.2 (range 1-10) months.
Early postoperative healing of the wound was uneventful in 180 patients (90%). No wound rupture or postoperative hematoma occurred. In five patients (2.5%), lumbar puncture or spinal drainage was necessary due to significant subcutaneous liquor collection. No wound revision was required. At follow-up, in 196 patients (98%) the postoperative scar was in perfect condition. Neither skin necrosis nor healing problems occurred.
Based on the result are that the high magnification of operating microscope to be beneficial when closing neurosurgical wounds; it allows (1) better hemostasis, (2) precise wound margin approximation, (3) atraumatic handling of the tissues, and (4) improvement of the manual dexterity of the neurosurgeon 4).
Wound therapy
see Wound therapy.