[Repair strategies and clinical outcomes for complex cervico-occipital wounds]

Objective: To investigate the repair strategies and clinical outcomes for complex cervico-occipital wounds. Methods: This study was a retrospective observational study. From March 2014 to December 2023, 31 patients with complex cervico-occipital wounds who met the inclusion criteria were admitted to the Department of Burns of Tongren Hospital of Wuhan University & Wuhan Third Hospital. There were 20 males and 11 females, aged 25-80 years, including 17 cases of radiation-induced ulcers, 8 cases of electrical burns, and 6 cases of necrotizing soft tissue infection. The wound sizes ranged from 8.0 cm×5.0 cm to 51.0 cm×21.0 cm on admission. All patients underwent multidisciplinary team collaborative diagnosis and treatment, systemic support therapy, followed by debridement and negative-pressure wound therapy on stage Ⅰ. After complete removal of necrotic tissue, the wound repair was performed on stage Ⅱ according to the wound feature. The free tissue flaps transplantation was performed in 22 cases, the pedicled tissue flaps transplantation was performed in 5 cases, and transplantation of local tissue flaps combined with split-thickness skin grafts from head was performed in 4 cases. The sizes of free tissue flaps ranged from 15.0 cm×8.0 cm to 45.0 cm×10.0 cm, the sizes of pedicled tissue flaps ranged from 11.0 cm×6.5 cm to 17.0 cm×8.0 cm, and te sizes of local tissue flaps ranged from 5.0 cm×3.5 cm to 7.0 cm×5.0 cm. All wounds in the donor sites of tissue flaps were closed directly. After the operation, functional rehabilitation training of cervico-occipital region and comprehensive scar treatment of the donor and recipient sites of tissue flaps were performed. The postoperative survival and appearance of tissue flaps, wound healing and recurrence of infection or ulcer in the donor and recipient sites of tissue flaps, and wound healing in the donor and recipient sites of skin grafts were observed. At the last follow-up, the scars in the donor and recipient sites of tissue flaps were evaluated by Vancouver scar scale (VSS), the pain, range of motion, muscle strength, and daily living ability of cervico-occipital region were evaluated by a self-made neck rehabilitation function assessment scale, and the satisfaction of patients with the therapeutic effect was surveyed by a literature-based method. Results: After surgery, all tissue flaps survived completely and had a good appearance, the wounds in the tissue flap donor and recipient sites healed well with no infection or ulcer recurrence, and the wounds in the donor sites of skin grafts healed well. The follow-up period was 6-48 months after stage Ⅱ surgery. At the last follow-up, among the 27 patients, the VSS scores of scar in the donor sites of tissue flaps were 2 in 16 cases, 3 in 7 cases, 5 in 2 cases, and 7 in 2 cases, and the VSS scores of scar in the recipient sites of tissue flaps were 3 in 17 cases, 4 in 8 cases, and 5 in 2 cases; the VSS scores of scar were 5 in 2 cases and 7 in 2 cases in cervico-occipital region among the other 4 patients. In the evaluation of rehabilitation function in cervico-occipital region, all patients were evaluated as excellent in terms of pain and muscle strength; 22 patients were evaluated as excellent, and 9 patients were evaluated as good in terms of activity and daily living ability. Among the patients, twenty-three patients were very satisfied with the therapeutic effect, 7 patients were relatively satisfied, and 1 patient was generally satisfied. Conclusions: A precise diagnosis and treatment system and personalized repair strategies based on multidisciplinary team collaboration, combined with postoperative systematic functional rehabilitation training and comprehensive scar management plan, can effectively promote the healing of complex wounds, improve the function of the cervico-occipital region, alleviate scars, and improve patient satisfaction, demonstrating significant clinical application value.