Risk Factors for Wound Dehiscence After Spinal Metastasis Surgery and a New Approach to Prevention—Curved Skin Incision

<b>Background</b>: Postoperative wound dehiscence is a major complication following spinal metastasis surgery, particularly in patients who receive preoperative radiotherapy or molecular-targeted therapy; however, preventive strategies remain limited. <b>Objective</b>: In this study, we aimed to identify the risk factors for postoperative wound dehiscence and evaluate the clinical utility of a novel curved skin incision (CSI) technique, designed to avoid irradiated areas, in comparison with the conventional midline incision (MI) technique. <b>Methods</b>: Logistic regression analysis was conducted on 107 patients who underwent MI between 2013 and 2018. Based on the results, we developed the CSI technique. Propensity score matching was performed to compare postoperative wound dehiscence in 29 matched pairs of patients treated with either CSI or MI from 2019 to 2021. <b>Results</b>: Preoperative radiotherapy and molecular-targeted therapy were found to be significant risk factors for wound dehiscence. CSI, which circumvents irradiated skin, was associated with a substantially lower rate of wound dehiscence than MI. <b>Conclusions</b>: The CSI technique offers a simple, reproducible, and effective surgical approach to reduce postoperative wound complications in high-risk patients. Its clinical benefit, especially for those with prior radiotherapy, suggests that it may serve as a valuable addition to standard spinal metastasis surgery.