PDF icon Download PDF
Open Access
CC BY 4.0 · J Neurol Surg Rep 2025; 86(02): e77-e82
DOI: 10.1055/a-2561-7951
Invited Report

The Question Mark Question: Wound Healing after Hemicraniectomy

Grace R. Fassina 
1   Department of Neurosurgery, University of Oklahoma, Oklahoma City, Oklahoma, United States
,
Emily E. Nguyen
1   Department of Neurosurgery, University of Oklahoma, Oklahoma City, Oklahoma, United States
,
David Cho
1   Department of Neurosurgery, University of Oklahoma, Oklahoma City, Oklahoma, United States
,
Drake J. Williams
1   Department of Neurosurgery, University of Oklahoma, Oklahoma City, Oklahoma, United States
,
Alexander R. Evans 
1   Department of Neurosurgery, University of Oklahoma, Oklahoma City, Oklahoma, United States
,
Panayiotis E. Pelargos
2   Department of Neurosurgery, Washington University in St. Louis, St. Louis, Missouri, United States
,
Christopher S. Graffeo
1   Department of Neurosurgery, University of Oklahoma, Oklahoma City, Oklahoma, United States
› Author Affiliations
› Further Information
Also available ateRefMedOne
  Permissions and Reprints
PreviewZoom

Abstract

Introduction

The reverse question mark (RQM) incision is the conventional scalp flap technique incorporated during decompressive hemicraniectomy (DHC) operations. Recently, the retroauricular (RA) incision emerged as a possible alternative. We sought to assess the contemporary literature regarding postoperative outcomes following RQM or RA for DHC and subsequent cranioplasty.

Methods

MEDLINE and Embase databases were queried using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting outcomes after primary DHC and secondary cranioplasty for both RQM and RA were included in a meta-analysis of proportions performed using random-effects modeling.

Results

Five manuscripts representing a total of 511 patients met the inclusion criteria. No difference was observed in the rate of primary surgical site infection (SSI) after RQM as compared with RA (OR = 1.64, 95% CI = 0.92–2.92). Similarly, based on those four studies reporting SSI data after cranioplasty, no difference was detected in secondary SSI rates between RQM and RA (OR = 1.93, 95% CI = 0.79–4.72). Patients who underwent primary RQM had increased odds of undergoing cranioplasty compared with patients who had received a primary RA (OR = 1.57, 95% CI = 1.03–2.39).

Conclusion

This novel systematic review and meta-analysis reported postoperative outcomes after DHC using either the RQM or RA incision technique. No significant difference was noted in SSI after either the primary decompression or the secondary cranioplasty. These findings support the use of either technique in routine practice, as guided by surgeon preference or other clinical considerations, such as superficial temporal artery preservation for an unrelated future indication.

Keywords

reverse question mark - retroauricular - wound complications - decompressive hemicraniectomy


Publication History

Received: 21 September 2024

Accepted: 25 December 2024

Accepted Manuscript online:
19 March 2025

Article published online:
09 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany