Stairstep Pericranial Incisions Are Associated With Reduced Wound Complications in Supratentorial Craniotomies for Malignant Brain Tumors: A Single-Institutional Comparative Cohort Analysis

BACKGROUND AND OBJECTIVES: Patients undergoing supratentorial craniotomies for malignant brain tumors often receive steroids, undergo radiation, experience hyperglycemia, and receive chemotherapy, all of which inhibit soft tissue healing. Poor wound healing can then lead to morbid sequelae (ie, bone flap infections) that derail clinical care by requiring subsequent operations, readmissions, and delayed initiation of cancer treatments. To minimize the clinical impact of inevitable poor wound healing in this population, we previously described a novel, multilayer incision with a stairstep through the pericranium to prevent progression of poor superficial wound healing to deeper infections. Here we compare wound-related outcomes from 200 consecutive cases using the stairstep incision technique with 200 similar consecutive cases performed with standard incisions. METHODS: We compared wound-related outcomes from 200 consecutive patients who underwent supratentorial craniotomies using the stairstep technique to a control group of 200 consecutive patients who underwent similar procedures using standard incisions at our institution. RESULTS: Overall, patients with stairstep pericranial incisions had fewer culture-positive infections (1.0% vs 5.0%; P = .04) and fewer readmissions for IV antibiotics (1.0% vs 6.5%; P = .01). While rates of early superficial wound concerns (ie, scabbing, focal dehiscence, or cellulitis) were similar between groups (6.0% pericranial vs 7.5% standard; P = .7), progression to morbid sequelae in the subgroup of people with superficial wound concerns was markedly lower after stairstep closure (0.0% vs 86.7%; P < .001). Specifically, rates of culture-positive infection (0.0% vs 66.7%; P < .001), IV antibiotics (0.0% vs 86.7%; P < .001), and reoperation (0.0% vs 60.0%; P < .01) were significantly lower in the group with early wound concerns who had stairstep pericranial incisions. CONCLUSION: Here we provide evidence that stairstep pericranial incisions are associated with fewer wound complications in supratentorial brain surgery, potentially due to protection against superficial wound issues progressing to clinically morbid sequelae. Prospective, randomized studies will assess the causal impact of the technique on wound-related outcomes.