The Question Mark Question: Wound Healing after Hemicraniectomy

Area of Science:

• Neurosurgery
• Surgical Techniques
• Evidence-Based Medicine

Background:

• The reverse question mark (RQM) incision is a standard technique for decompressive hemicraniectomy (DHC).
• The retroauricular (RA) incision is a recently proposed alternative for DHC procedures.
• Assessing comparative postoperative outcomes between RQM and RA incisions is crucial for surgical decision-making.

Purpose of the Study:

• To systematically review and meta-analyze contemporary literature comparing postoperative outcomes of RQM versus RA incisions in DHC and subsequent cranioplasty.
• To evaluate the incidence of surgical site infections (SSI) following both primary DHC and secondary cranioplasty procedures using either incision technique.
• To compare the likelihood of undergoing cranioplasty after initial DHC based on the incision type used.

Main Methods:

• A systematic literature search was conducted using MEDLINE and Embase databases, adhering to PRISMA guidelines.
• Studies reporting outcomes for both RQM and RA incisions in DHC and cranioplasty were included.
• A meta-analysis of proportions was performed using random-effects modeling to compare outcomes.

Main Results:

• Five studies with 511 patients were included in the meta-analysis.
• No significant difference in primary or secondary surgical site infection (SSI) rates was observed between RQM and RA incisions.
• Patients undergoing primary DHC with an RQM incision had a statistically higher likelihood of proceeding to cranioplasty compared to those with an RA incision.

Conclusions:

• This systematic review and meta-analysis found no significant difference in SSI rates between RQM and RA incisions for DHC and cranioplasty.
• Both RQM and RA incision techniques are viable options for DHC, with selection potentially guided by surgeon preference or specific clinical needs.
• Consideration for future procedures, such as superficial temporal artery preservation, may influence the choice of incision.