Wound healing after craniotomy: a randomized trial comparing scalp clips to artery forceps for scalp hemostasis.
OBJECTIVE
In this prospective randomized clinical trial, investigators looked at wound healing after craniotomy. The hypothesis was that the self-closing plastic scalp clips used for hemostasis on the skin edge might lead to localized microscopic tissue damage and subsequent delayed wound healing.


METHODS
The trial consisted of 2 arms in which different methods were used to secure scalp hemostasis: 1) the routinely used plastic clips (Scalpfix, Aesculap); and 2) the older method of artery forceps placed on the galea. Participants were restricted to those > 16 years of age undergoing craniotomies expected to last > 2 hours. Repeat operations were not included. One hundred fifty patients were enrolled. They were visited at 3 and 6 weeks postoperatively by an observer blinded to the method used, and the wounds were assessed for macroscopic epithelial closure, signs of infection, and hair regrowth by using a predefined assessment scale.


RESULTS
The results showed no significant difference in wound healing between the 2 groups at either 3 weeks (OR 0.55, 95% CI 0.27-1.11; p = 0.09) or 6 weeks (OR 0.79, 95% CI 0.39-1.58; p = 0.50). The length of operation was found to be a significant factor affecting wound healing at 6 weeks (OR/hour 0.68, 95% CI 0.51-0.92; p = 0.01).


CONCLUSIONS
The use of Aesculap Scalpfix self-retaining plastic scalp clips on the skin edge during craniotomy surgery does not appear to affect wound healing significantly to the postoperative 6-week mark.
Langford
Peter
P
Department of Neurosciences, Monash Medical Centre, Monash University, Melbourne, Australia. rhlangford@internode.on.net.
Wolfe
Rory
R
Danks
R Andrew
RA
D003399:Craniotomy / Q000009:adverse effects / Q000295:instrumentation; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D016017:Odds Ratio; D010969:Plastics; D011446:Prospective Studies; D012535:Scalp / Q000293:injuries*; D012720:Severity of Illness Index; D013525:Surgical Instruments / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing
D010969:Plastics