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
