Clinical experience in treatment of delayed would healing after craniotomy

Objective To discuss the risk factors and therapeutic options of delayed would healing after craniotomy. Methods Sixteen patients with poor would healing after craniotomy, admitted to our hospital from January 2012 to September 2016, were chosen in our study. The secretion culture results, imaging findings, devastating infections, paranasal sinuses, would debridement and prognoses were analyzed. Results All 16 patients were treated with artificial materials in the initial operations. The paranasal sinuses were confirmed open during operation in 7 patients by comparison of preoperative imaging. Six patients who had positive results by secretion culture were cured through removal of the artificial materials and bone flap during the first debridement surgery; 4 of the 10 patients who had negative results were cured only by removing artificial materials during the first debridement surgery, and the remaining 6 were cured with reoperation through removal of the bone flap. Conclusions Chronic infection caused by bacteria, which mainly comes from surgical field and paranasal sinuses, is important to elucidate the mechanism of delayed would healing after craniotomy. The implants and autologous tissues have important roles in this process. Early complete debridement is very critical on such infected would, meanwhile we must repack the ostia of the sinuses based on preoperative images, and relax the indications for throwing the bone flap. Key words: Would healing; Would infection; Implant; Paranasal sinus