Multidisciplinary management of complex scalp wounds: an experience-based algorithm for involving plastic surgeons in complex neurosurgical wound closure.

[OBJECTIVE] In complex cranial wound closures, plastic and reconstructive surgeons provide advanced techniques to improve healing and reduce complications, including infection. Although this multidisciplinary approach shows promise, data supporting its routine use remain limited. The authors performed an evaluation of neurosurgical patients requiring plastic and reconstructive surgical interventions for complex scalp wounds to assess the reconstructive techniques used and associated outcomes.

[METHODS] A retrospective analysis was conducted on patients jointly treated by neurosurgery and plastic and reconstructive surgery at the University Hospital Zurich in the period from 2016 to 2023. Patients aged 16 years or older with informed consent were eligible for inclusion. Collected data encompassed demographics, primary diagnoses, wound healing risk factors, procedural details, and outcomes.

[RESULTS] Thirty-seven patients with a mean age 60.8 years were included in the study; 56.8% were female. Most cases were oncological (73.0%), and among this group, 51.3% had received prior radiotherapy. Overall, patients had a mean of 3.8 previous cranial surgeries. Preexisting wound healing impairment or infection was present in 64.9% of patients. A total of 47 procedures involved plastic and reconstructive surgeons, whose involvement was secondary (after failed primary closure) in 85.1% of cases. Free flaps (46.8%) and local flaps (38.3%) were the most common reconstructions. Postoperative local scalp wound complications occurred in 34.0% of cases (16/47), and 25.5% (12/47) required rehospitalization for revision surgery. No free flap failures occurred. The mean operating time was 266.5 minutes, and the mean hospital stay was 12.4 days.

[CONCLUSIONS] Patients with complex scalp defects, especially after multiple surgeries or radiotherapy, remain at high risk for wound complications and infection despite advanced reconstruction. Early plastic and reconstructive surgeon involvement and interdisciplinary planning may be helpful in reducing infection risk and improving outcomes. Proactive identification of high-risk cases for plastic surgery consultation is recommended to enhance wound closure and prevent cranial wound infections. Prospective studies are needed to confirm these strategies.