A prospective randomized comparison of functional and cosmetic outcomes of a coronal zigzag incision versus a conventional straight incision pattern for craniotomy.

OBJECTIVE: Wound healing problems after neurosurgical procedures can lead to serious complications and may require complex revision or even reconstructive surgery. Therefore, optimal surgical management is critical to prevent complications. In a recent experimental study in animals, the authors demonstrated the superiority of a zigzag skin incision over a straight incision pattern. In this study, the authors applied these findings to clinical situations of neurosurgical patients with an indication for a coronal skin incision. The aim of this study was to objectively assess the functional and cosmetic outcomes between straight coronal and zigzag incisions in neurosurgical procedures. METHODS: This prospective, randomized, controlled, single-center trial included adult patients undergoing frontal craniotomy for cerebrovascular or tumor pathologies. The study primarily included patients who were not expected to receive adjuvant radiation or chemotherapy. The zigzag incision was standardized using a template. A common straight skin incision behind the hairline served as a control. Complication rates, functional (2-point discrimination, width of the wound, Vancouver Scar Scale [VSS], and Patient and Observer Scar Assessment Scale [POSAS]), and cosmetic outcomes were assessed postoperatively and at 3-month follow-up evaluations. Additionally, all patients answered a wound-specific questionnaire and the SF-36 questionnaire. RESULTS: Twenty-eight patients were randomized to the zigzag and 29 to the straight incision groups. Indications for surgery were cerebrovascular in 16 cases and tumors in 41 cases. Risk factors for wound healing were equally distributed in both groups. One patient in the zigzag group with poor postoperative compliance required surgery for secondary wound healing problems. Overall, the width of the scar was significantly smaller (p = 0.001) and local 2-point discrimination better (p = 0.005) in the zigzag group. Scores on the VSS (p = 0.003) and POSAS (p = 0.005) proved to be significantly superior in the zigzag group as well. CONCLUSIONS: A zigzag coronal skin incision pattern leads to significantly superior functional and cosmetic outcome scores. For certain patient groups, these findings may prove to be practice-changing.

Finding the Optimal Surgical Incision Pattern-A Biomechanical Study.

The closure of wounds and subsequent optimal wound healing is essential to any successful surgical intervention. Especially on parts of the body with limited possibilities for local reconstruction, optimal distribution of load is essential. The aim of the present study was therefore to examine three different incision patterns, conventional straight, Lazy-S and Zigzag, with regard to their biomechanical stability and mode of failure on a porcine skin model. Our results demonstrate the superior biomechanical stability of Lazy-S and Zigzag incision patterns with perpendicular suture placement. This holds true, in particular, for Zigzag incisions, which showed the highest values for all parameters assessed. Moreover, the observed superior stability of Lazy-S and Zigzag incision patterns was diminished when sutures were placed in tensile direction. The conventional straight incision represents the standard access for a large number of surgical procedures. However, we were able to demonstrate the superior biomechanical stability of alternative incision patterns, in particular the Zigzag incision. This is most likely caused by an improved distribution of tensile force across the wound due to the perpendicular placement of sutures. Moreover, this technique offers additional advantages, such as a better overview of the operated area as well as several cosmetic improvements. We therefore advocate that the surgeon should consider the use of a Zigzag incision over a conventional straight incision pattern.