Absorbable intradermal closure of elective craniotomy wounds

More and more commonly, craniotomies are being performed with minimal hair shaving to improve cosmesis and facilitate return to a normal life. In such patients, traditional sutures or metal staples are used for scalp closure. This practice requires suture removal, often perceived as a cause of discomfort by the patient. We investigate the safety and efficacy of intradermal sutures in a large, consecutive series of patients undergoing elective craniotomy.

Wound healing complications were investigated in a consecutive series of 208 patients who underwent elective craniotomy during a 2-year period. In all patients, minimal shaving, performed by shaving a small strip of hair along the planned wound, was used. Scalp closure was achieved with only absorbable intradermal running sutures. All wounds were covered with sterile adhesive strips, which were kept in place for 24 hours postoperatively. Patients were followed for a mean follow-up period of 10.6 months (range, 1-23 mo).

All patients except two had satisfactory wound healing. One patient (0.48%) developed cerebrospinal fluid leakage, which responded to bed rest and lumbar drainage. Another patient (0.48%) had a superficial skin infection, which was successfully treated with topical wound care and oral antibiotics.

The closure method described is safe and effective. The absence of visible sutures in the postoperative course reinforces the cosmetic advantage of no shaving and decreases discomfort associated with the removal of sutures or staples.