[Repair methods for refractory head wounds involving intracranial structures and their clinical effectiveness]

Objective: To investigate the repair methods for refractory head wounds involving intracranial structures and their clinical effectiveness. Methods: This study was a retrospective observational study. From September 2020 to July 2024, 68 patients with refractory head wounds involving intracranial structures who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of Xiangya Hospital of Central South University (hereinafter referred to as our hospital) and were co-managed with neurosurgeons from our hospital. Among them, 38 were male and 30 were female, aged 1 to 76 years. Based on the causes of difficult wound healing, the refractory head wounds involving intracranial structures were classified into 5 categories: simple tissue defect wounds, simple infectious wounds, implant-related wounds, wounds communicating with paranasal sinuses, and radiation-damaged wounds. Corresponding management plans were adopted according to the wound condition. After wound bed preparation was completed, according to factors such as wound location, size, blood supply condition, need for soft tissue filling, and the patient's general condition, and also following the principle of minimizing damage, patients with no obvious scalp soft tissue defect were sutured directly. For patients with large defects that could not be sutured directly (with wound area of 8 cm×3 cm to 28 cm×13 cm), the most suitable tissue flaps (including pedicled scalp flaps and free tissue flaps) were designed to repair the wounds. The donor site wounds of scalp flaps were directly sutured or repaired by full-thickness skin grafting and the donor site wounds of free tissue flaps were directly sutured. Before surgery, the types of refractory wounds and the microbial culture results of wound exudate specimens were recorded. During surgery, the wound repair methods, types of free tissue flaps, recipient vessels, and vascular anastomosis methods between donor and recipient sites were recorded. After surgery, the recovery of the head wounds and the tissue flap donor sites was observed. The recipient site appearance, blood supply, wound recurrence, and subsequent management were followed up. Results: Among 68 patients, 2 cases had simple tissue defect wounds, 15 cases had simple infectious wounds, 43 cases had implant-related wounds, 4 cases had wounds communicating with paranasal sinuses, and 4 cases had radiation-damaged wounds. Before surgery, the microbial culture results of wound exudate specimens were positive in 28 cases. After wound bed preparation was completed, the wounds of 17 patients were sutured directly, the wounds of 31 patients were repaired with pedicled scalp flap transfer, and the wounds of 20 patients were repaired with free tissue flap transplantation. Of the 20 patients who underwent free tissue flap transplantation for wound repair, 12 patients had the superficial temporal arteries and veins as the recipient vessels and 8 patients had the facial arteries and veins as the recipient vessels. Among them, 2 patients had their blood vessels anastomosed using a flow-through technique, while the remaining 18 patients underwent end-to-end anastomosis between donor and recipient vessels. After surgery, the head wounds of 66 patients healed, and the head wounds of 2 patients did not heal, which healed after undergoing debridement surgery again. All tissue flap donor sites recovered well. During follow-up of 6 to 32 months, all patients had good blood supply in the recipient sites, acceptable head shape, and no wound recurrence. Among them, 4 patients underwent titanium mesh reimplantation after scalp expansion at a later stage, and 2 patients developed new-onset epilepsy which was controlled with medication. Conclusions: Based on an adequate assessment of the causes of difficult wound healing, targeted removal of factors affecting wound healing, and use of direct suture, pedicled scalp flap transfer, or free tissue flap transplantation to repair complex refractory head wounds involving intracranial structures can achieve favorable clinical treatment outcomes.