title: A Faster and Wider Skin Incision Technique for Decompressive Craniectomy: n-Shaped Incision for Decompressive Craniectomy.
abstract: OBJECTIVE
  Decompressive craniectomy (DC) is a useful surgical method to achieve adequate decompression in hypertensive intracranial patients. This study suggested a new skin incision for DC, and analyzed its efficacy and safety.
  
  
  METHODS
  In the retrograde reviews, 15 patients underwent a newly suggested surgical approach using n-shape skin incision technique (Group A) and 23 patients were treated with conventional question mark skin incision technique (Group B). Two groups were compared in the terms of the decompressed area of the craniectomy, protruded brain volume out of the skull layer, the operation time from skin incision to bone flap removal, and modified Rankin Scale (mRS) which was evaluated for 3 months after surgery.
  
  
  RESULTS
  The decompressed area of craniectomy (389.1 cm2vs. 318.7 cm2,p=0.041) and the protruded brain volume (151.8 cm3vs. 116.2 cm3,p=0.045) were significantly larger in Group A compared to the area and the volume in Group B. The time interval between skin incision and bone flap removal was much shorter in Group A (23.3 minutes vs. 29.5 minutes,p=0.013). But, the clinical results were similar between 2 groups. Group A showed more favorable outcome proportion (mRS 0-3, 6/15 patients vs. 5/23 patients,p=0.225) and lesser mortality cases proportion 1/15 patients vs. 4/23 patients, but these differences were not significantly observed (p=0.225 and 0.339).
  
  
  CONCLUSIONS
  DC using n-shaped skin incision was a feasible and safe surgical technique. It may be an easier and faster method for the purpose of training neurosurgeons.
authors.affiliation: Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea.
authors.forename: Ho Seung
authors.initials: HS
authors.lastname: Yang
authors.affiliation: Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea.
authors.forename: Dongkeun
authors.initials: D
authors.lastname: Hyun
authors.affiliation: Department of Neurosurgery, Guro Cham Teun Teun Hospital, Seoul, Korea.
authors.forename: Chang Hyun
authors.initials: CH
authors.lastname: Oh
authors.affiliation: Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea.
authors.forename: Yu Shik
authors.initials: YS
authors.lastname: Shim
authors.affiliation: Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea.
authors.forename: Hyeonseon
authors.initials: H
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea.
authors.forename: Eunyoung
authors.initials: E
authors.lastname: Kim
keywords: Decompressive craniectomy; Dermatologic surgical procedures; Surgical flaps; Surgical procedures, operative