Risk factors for wound healing complications after revascularization for MMD with complete Y-shaped incision
Chenchao Wang1, Hongwei Li1, Yang Dong1
1Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Erqi District, Zhengzhou, 450053, Henan, China.
Abstract:
Moyamoya disease (MMD) is a chronic occlusive cerebrovascular disease that can be treated with revascularization. Surgery increases the risk of poor wound healing (PWH) due to the impact on the blood supply to the flap. We aimed to analyze risk factors for PWH in MMD with a complete Y-shaped incision. A total of 125 patients with MMD were enrolled in this prospective observational study. The wounds were assessed and measured on the third and seventh days after surgery. The mean age of these patients was 43.3 ± 10.0 years. The ratio of male to female was 1:1.3. 15 (12.0%) patients had incision complications. 5 patients (4.0%) had redness; 2 patients (1.6%) had swelling; 2 patients (1.6%) had fat necrosis; 3 patients (2.4%) had incision infection; and 3 patients (2.4%) had flap necrosis. Student's t test showed significant differences in BMI (P = 0.040) and fever time (P = 0.050). The standard chi-squared test showed significant differences in incision infection (P = 0.010), suture mode (P = 0.047), and cutting off large branch vessels in the flap (P < 0.001). Multivariate logistic regression analysis suggested that incision infection (P = 0.026, OR 12.958), using a skin stapler (P = 0.030, OR 4.335), cutting off large branch vessels in the flap (P = 0.009, OR 5.227), and BMI (P = 0.027, OR 1.204) were risk factors. The area under the curve for risk factors for PWH on a receiver operating characteristic curve was 0.853. Incision infection, using a skin stapler, higher BMI, and cutting off large branch vessels in the flap are risk factors for PWH.
Insights
Poor wound healing after Moyamoya disease surgery is linked to incision infections, skin stapler use, higher BMI, and cutting large flap vessels. These factors increase complication risks in revascularization procedures.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Surgical Complications
Background:
- Moyamoya disease (MMD) is a cerebrovascular condition requiring revascularization surgery.
- Revascularization surgery for MMD carries a risk of poor wound healing (PWH) due to compromised blood supply to surgical flaps.
- Identifying risk factors for PWH is crucial for improving patient outcomes.
Purpose of the Study:
- To analyze risk factors associated with poor wound healing (PWH) in Moyamoya disease patients undergoing revascularization with a Y-shaped incision.
- To identify specific surgical and patient-related factors that predict PWH.
Main Methods:
- A prospective observational study involving 125 Moyamoya disease patients who underwent revascularization surgery.
- Wound assessment and measurement were performed on postoperative days 3 and 7.
- Statistical analyses included Student's t test, chi-squared test, and multivariate logistic regression.
Main Results:
- 12.0% of patients experienced incision complications, including infection and flap necrosis.
- Significant risk factors identified through multivariate analysis were incision infection (OR 12.958), skin stapler use (OR 4.335), cutting large branch vessels in the flap (OR 5.227), and higher BMI (OR 1.204).
- The receiver operating characteristic curve indicated good predictive value (AUC 0.853) for the identified risk factors.
Conclusions:
- Incision infection, use of skin staplers, higher body mass index (BMI), and transection of large branch vessels in the flap are significant risk factors for poor wound healing in Moyamoya disease patients.
- These findings can inform surgical technique and patient management to mitigate PWH risks.
