Introduction: Traditional scalp closure technique following elective craniotomy involves placement of staples or a continuous running suture. Despite low complication rates, these techniques are often considered to be disfiguring by patients, contribute to the psychosocial trauma of brain surgery, and are associated with discomfort during postoperative staple or suture removal. Some authors advocate for absorbable intradermal closure, although this technique requires knot tying, which may be time consuming and is associated with knot-related complications.
Methods: We employed a novel barbed intradermal closure method in supratentorial elective craniotomies for tumor resection. Hair sparing craniotomy techniques were used for the opening. Skin closure was accomplished with a barbed 3-0 monocryl suture run in a subcuticular fashion at the dermal-epidermal junction, approximately 1 mm below the skin surface. Complication rates were recorded, and cosmetic outcomes were informally assessed.
Results: Intradermal closure with barbed sutures was utilized in 76 patients. At the two week postoperative clinic visit, cosmetic outcomes were excellent in all cases. There was one superficial wound infection which presented six weeks after a pterional craniotomy for low grade glioma. This resolved with superficial wound revision and oral antibiotic therapy.
Conclusions: We present a novel scalp closure technique for craniotomies using intradermal barbed monocryl suture. We have had excellent cosmetic outcomes, and the infection rate of 1.3% compares favorably to published rates. As skin closure is the only component of any surgery visible to patients it contributes significantly to patient satisfaction. Further studies are required to quantify the improvement in patient satisfaction compared to conventional closure methods.
Patient Care: This report describes a novel technique of scalp closure using a barbed absorbable intradermal suture. This has led to excellent cosmetic outcomes and obviates the need for suture or staple removal at follow up. The barbs help create high tensile strength in the wound without the risk for tissue strangulation seen with traditional running suture. This technique can be used for most elective craniotomies and appears to positively affect patient satisfaction.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the technique for intradermal craniotomy scalp closure using barbed absorbable suture
2) Highlight the benefits of this approach to wound cosmesis, patient satisfaction, and possibly infection rates