Introduction: Superficial temporal artery (STA) to middle cerebral artery (MCA) bypass is associated with several surgical problems. Despite the vascular patency and hemodynamic changes after the anastomosis, wound problems can be a major surgical complication.

Methods: In a review of 41 surgical cases of STA-MCA bypass for moyamoya disease and cerebral occlusive vascular diseases, we compared the conventional (“Out-to-In”) dissection method for STA (n=23) with the “In-to-Out” (ITO) dissection method (n=18) and evaluated the surgical results with respect to wound problems.

Results: The incidence of skin maceration was significantly higher in the conventional dissection group than the ITO dissection group (34.8% vs. 5.5%; p<0.01). Skin necrosis also showed a higher incidence in the conventional dissection group (39.1%) than the ITO group (22.2%).

Conclusions: These data suggest that the “layering” technique for surgical wounds protects against contamination from bacteria of the hair follicles. Sealing of galea aponeurotica (1st protective barrier) including fibrous septa, and loose areolar tissues including the periosteal layer (2nd protective barrier) is an important factor to decrease the rate of scalp wound infection.

Patient Care: Decreasing the post-operative wound infection in micro-vascular anastomosis

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of post-operative wound complication after bypass surgery, 2) Discuss, different type of donor artery dissection method for micro-vascular anastomosis, 3) Identify an "layering" technique for surgical wound.

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