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Hair-sparing technique using absorbable intradermal barbed suture versus traditional closure methods in supratentorial craniotomies for tumor

  • Original Article - Brain Tumors
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Abstract

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.

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Authors and Affiliations

  1. Department of Neurological Surgery, Lois Pope Life Center, University of Miami Miller School of Medicine, Jackson Health System, 2nd floor 1095 NW 14th Terrace, Miami, FL, 33136, USA

    Evan Luther, Katherine Berry, David McCarthy, Daniel G. Eichberg, Simon Buttrick, Ashish Shah, Angela M. Richardson, Ricardo Komotar & Michael Ivan

  2. University of Miami MILLER School of Medicine, Miami, FL, USA

    Jagteshwar Sandhu

  3. Neuroscience Department, University of Miami, Miami, FL, USA

    Roxanne Mayrand

  4. Boston University School of Medicine, Boston, MA, USA

    Christina Guerrero

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  1. Evan Luther
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Correspondence to Evan Luther.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (University of Miami IRB #20160437) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Comments

The authors compare different hair-sparing techniques in patients undergoing craniotomy for brain tumors by a single surgeon. The study has several limitations primarily related to differences among the three groups considered. Nevertheless, the study provides further evidence that no-shaving intradermal closure does not increase wound complication rates. No or minimally shaving techniques improve patients sense of well-being after craniotomy and facilitate a quicker psychological recovery. Based on this and other works, these techniques do not seem to increase wound complications and should be encouraged and adopted especially among younger neurosurgeons.

Giuseppe Lanzino

USA

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This article is part of the Topical Collection on Brain Tumors

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Florida Neurosurgical Society Annual Meeting, August 2–4, 2019. The Breakers Palm Beach, One South County Road, Palm Beach, FL 33480. Oral podium presentation.

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Luther, E., Berry, K., McCarthy, D. et al. Hair-sparing technique using absorbable intradermal barbed suture versus traditional closure methods in supratentorial craniotomies for tumor. Acta Neurochir 162, 719–727 (2020). https://doi.org/10.1007/s00701-020-04239-3

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