Object: Intracranial revascularization surgeries are an effective treatment for moyamoya disease and other intracranial vascular obliterative diseases. However, in some cases, wound-related complications develop after surgery. Although the incidence of wound complication is supposed to be higher than that with a usual craniotomy, this complication has rarely been the focus of studies in the literature that report the outcomes of revascularization surgeries. Here, the relationship between intracranial revascularization surgeries and their complications is statistically assessed.
Methods: Between October 2004 and February 2010, 71 patients were treated using cerebral revascularization surgeries on 98 sides of the head. The relationship between wound complications and operative technique was retrospectively assessed. Multivariate logistic regression analysis was performed to identify the risk factors of wound complication, including operative technique, age, sex, diabetes mellitus (DM), hypertension, hyperlipidemia, and smoking history.
Results: In total, there were 21 (21.4%) operative wound complications. Of these 21 complications, there were 14 (66.7%) minor complications and 7 (33.3%) major complications. No statistically significant relationship was found between wound complications and any surgical procedure. A trend toward severer complications was demonstrated for the procedures that used both STA branches ("double" procedures) in comparison with the procedures that used only 1 STA branch ("single" procedures, p=0.016, Cochran-Armitage trend test). Multivariate logistic regression analysis also revealed that double procedures demonstrated a significantly higher incidence of wound complications than single procedures (OR 3.087, p=0.048). DM was found to be a risk factor for wound complication (OR 9.42, p=0.02), but age, sex, hypertension, and hyperlipidemia were not associated with the incidence of complications. Even though the blood supply to the scalp is abundant due to 5 arteriovenous systems, sometimes cutaneous necrosis develops after intracranial revascularization surgeries. The galeal blood supply is thought to be crucial for preventing wound-related complications. Special care is also thought to be required for DM patients.
Conclusions: Revascularization surgeries seemed to demonstrate a higher risk of wound-related complications. Double-type procedures, which use both branches of the STA, and a history of DM were found to be risk factors for wound-related complications. Attention should be paid to the design of the galeal incision and vessel harvest line. Also, special attention should be paid to patients with DM.
Keywords: BA = basilar artery; DM = diabetes mellitus; EDAMS = encephalo-duro-arterio-myo-synangiosis; EDAS = encephalo-duro-arterio-synangiosis; EMS = encephalo-myo-synangiosis; ICA = internal carotid artery; MCA = middle cerebral artery; MMD = moyamoya disease; SCA= superior cerebral artery; SPECT = single-photon emission computed tomography; STA = superficial temporal artery; STSG = split-thickness skin graft; cranial revascularization surgery; extracranial to intracranial bypass; infection; skin necrosis; superficial temporal artery-to-middle cerebral artery anastomosis; vascular disorders; wound-related complication.