Wound dehiscence from a prominent external occipital protuberance: An indication for prophylactic drilling?
| Autor: | Brian T. Jankowitz, Nitin Agarwal, Christian B. Ricks |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment lcsh:Surgery Wound Breakdown Dehiscence lcsh:RC346-429 03 medical and health sciences 0302 clinical medicine medicine medicine.bone lcsh:Neurology. Diseases of the nervous system Craniotomy Wound dehiscence business.industry lcsh:RD1-811 medicine.disease Surgery 030220 oncology & carcinogenesis Vomiting External occipital protuberance Neurology (clinical) medicine.symptom business Complication 030217 neurology & neurosurgery External ventricular drain |
| Zdroj: | Interdisciplinary Neurosurgery, Vol 10, Iss, Pp 49-51 (2017) |
| ISSN: | 2214-7519 |
| DOI: | 10.1016/j.inat.2017.06.005 |
| Popis: | Background: Wound complications including CSF leaks, pseudomeningoceles, and infections after a craniotomy is a known risk, but dehiscence after suboccipital approaches remain a rare event. Objective: Here we present a patient whose exceptionally prominent external occipital protuberance caused wound breakdown after a suboccipital craniotomy, and suggest that prophylactic drilling of this protuberance would have prevented this complication. Methods: A 52 year old male on Aspirin and Plavix presents with sudden onset headache, nausea, and vomiting, with a computed tomography (CT) scan of the head showing a 60 cm3 right cerebellar hemorrhage. He underwent a suboccipital paramedian craniotomy for hematoma evacuation, and external ventricular drain placement. His hospitalization was complicated by respiratory failure, pneumonia, bacteremia, and finally sterile wound breakdown over his prominent external occipital protuberance 5 weeks after his initial operation. Results: The wound was debrided and his 14 mm tall occipital protuberance drilled flush allowing for excellent healing without further complications. Conclusion: While the incidence of prominent external occipital protuberances is unknown, we suggest that surgeons consider prophylactic drilling of this prominence or making a paramedian incision when performing suboccipital approaches to prevent subsequent wound complications. Keywords: Occipital protuberance, Wound dehiscence, Suboccipital craniotomy |
| Databáze: | OpenAIRE |
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