Risk factors for wound dehiscence after surgery for epilepsy

Wound dehiscence following craniotomy is a complication for which patients are subjected to additional procedures to achieve wound closure. During surgery for epilepsy, a craniotomy is performed at various sites to cure or palliate seizures in patients with intractable epilepsy. Collaborations between medicine and engineering have provided many surgical devices and materials for various stages of craniotomy, from skin incision to wound closure. The risk factors for wound dehiscence remain undetermined. Here, the authors attempt to identify risk factors associated with wound dehiscence after surgery for epilepsy.

They retrospectively reviewed the clinical records and operative notes of consecutive patients with intractable epilepsy who had undergone craniotomy to allow resective or disconnective surgery between 2015 and 2023 in the Department of Neurosurgery, Hiroshima University Hospital, and had a minimum follow-up of 1 year. The authors conducted a multivariate logistic regression analysis to determine the risk factors for wound dehiscence.

The study population comprised 174 patients who had undergone corpus callosotomy (70 patients), cortical resection (CR; 65 patients), or CR via intracranial video electroencephalography monitoring (IVEEG; 39 patients). Wound dehiscence occurred in 14 patients (8.0%). Univariate analysis showed that wound dehiscence was associated with CR via IVEEG (p = 0.0330), electrocautery scalpels (p = 0.0037), T-shaped skin incisions (p = 0.0216), dural closure (p = 0.0002), and longer operative duration (p = 0.0088). Multivariate logistic regression analysis revealed that skin incision using an electrocautery scalpel (p = 0.0462, OR 9.38, 95% CI 1.04-84.74) and dural closure using nonabsorbable artificial dura (p = 0.0078, OR 6.29, 95% CI 1.63-24.31) were independent risk factors for wound dehiscence.

Surgical devices and materials contribute to wound dehiscence after epilepsy surgery. To avoid wound dehiscence, the use of an electrocautery scalpel is not recommended when performing skin incisions, nor is dural closure using a nonabsorbable artificial dura.