Scalp thickness as a predictor of wound complications after cerebral revascularization using the superficial temporal ar
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ORIGINAL ARTICLE - VASCULAR NEUROSURGERY - OTHER
Scalp thickness as a predictor of wound complications after cerebral revascularization using the superficial temporal artery: a risk factor analysis Jaewoo Chung 1 & Seungjoo Lee 2 & Jung Cheol Park 2 & Jae Sung Ahn 2 & Wonhyoung Park 2 Received: 25 May 2020 / Accepted: 15 July 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Objective Cerebral revascularization using the superficial temporal artery diverts some of the blood supply from the scalp to the brain. This may compromise the blood supply to the scalp and could result in more wound complications. Objective This retrospective chart review aimed to identify the incidence of, and independent risk factors for, wound complications after cerebral revascularization using the superficial temporal artery. Methods Patients who underwent cerebral revascularization using the superficial temporal artery between January 2003 and February 2017 were studied. Minor wound complications included superficial skin necrosis, and mild wound dehiscence, while major wound complications included full-thickness skin necrosis, deep infection, and osteomyelitis that required additional surgical treatment. Results A total of 482 cerebral revascularization procedures using the superficial temporal artery were included. Wound complications developed in 32 cases (6.6% of the total), including 7 classified as major in severity (1.5% of the total). The multivariate analysis revealed diabetes mellitus (odds ratio 4.058, p = 0.001), low body mass index (odds ratio 1.21, p = 0.009), and thin scalp (odds ratio 1.82, p < 0.001) as the main risk factors for wound complications. Every 1-mm increase in scalp thickness was associated with a protective effect on wound complications (odds ratio 0.549). Conclusion Cerebral revascularization using the superficial temporal artery was associated with a relatively high incidence of wound complications. Diabetes mellitus, low body mass index, and thin scalp were found to be independent risk factors for wound complications. The thickness of the scalp could be a useful predictor of wound complications. Keywords Extracranial-intracranial bypass . Scalp thickness . Diabetes mellitus . Body mass index
Introduction The scalp layer includes skin, dense subcutaneous tissue, galea aponeurosis, loose areolar connective tissue, and pericranium. It has a rich arterial vascular supply from the superficial temporal arteries (STA), occipital arteries, This article is part of the Topical Collection on Vascular Neurosurgery Other * Wonhyoung Park [email protected] 1
Department of Neurosurgery, Dankook University Hospital, Cheonan, South Korea
2
Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
posterior auricular arteries, supraorbital arteries, and supratrochlear arteries [11, 12]. Wound complications after brain surgery occur in 2.3% to 4.2% of cases [5, 6, 9, 15]. The majority of wound complic
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