Preventing Cranial Wound Complications in Cancer Patients

Patients undergoing resection for intracranial neurosurgical tumors pose unique issues for the reconstructive team, and consideration needs to be given for not only the initial resection but also for possible future resections. A strong understanding of the anatomy of the overlying soft tissue is important to prevent ischemic complications. Patients undergoing re-operative cases are at higher risk for infections, wound dehiscence, and skin necrosis which all stem from decreased blood flow and tension in the scalp from prior scarring. The combination of poor nutrition, immunosuppressive agents, and radiation all pose specific risks to the postoperative patient which needs to be considered in the operative planning. Proper technique must be used to minimize tissue ischemia with appropriate planning of incisions, assessment of scalp perfusion, and management of the patient in the immediate postoperative period. In re-operative cases or high-risk patients, collaboration with a reconstructive surgeon is appropriate to achieve stable, well-vascularized soft tissue coverage over areas of concern.