Neuroplastics Wound Healing Protocol

LHH Neuroplastics Wound Healing Bundle:

1. Vitamin and mineral supplementation – can be started on all patients
   1. Vit A 20K units daily x 7d
   2. Ascorbic aid 500mg BID x 7d
   3. Zinc sulfate 220mg PO x7d
   4. MVI daily x 7d
2. Supplemental oxygens 2L / nasal cannula x 48h
3. Fluid supplementation – 15cc/Kg/day x48h
   1. Neurointensivists and hospitalists (on stepdown) to decide on fluid supplementation
   2. in the absence of increased risk (CHF, renal disease, liver disease, overloaded state, elderly

Review of the article: Low-Cost Wound Healing Protocol Reduces Infection and Reoperation Rates After Cranioplasty: A Retrospective Cohort Study

• nonrandomized, single-institution, retrospective chart review
• b= 291 (control) vs 68 (protocol)

Wound Healing Protocol (from study)

1. Components
   1. Vitamin and mineral supplementation x  7 days
      1. vitamin A 20,000 units daily
      1. ascorbic acid 500mg BID
      1. zinc sulfate 220mg daily
   1. Fluid supplementation until discharge or x7d (whichever sooner) – continuous sodium chloride 0.9% infusion at a minimum of 15 ml/Kg/day
   1. Oxygen support until discharge or x7d (whichever sooner) – 2L supplemental O2via nasal cannula even in the absence of other oxygen requirement
2. Starts post-op Day 0

Outcomes:

1. RTOR within 30d same -(odds ratio [OR] 2.21 [95% CI 0.76-6.47], P = .145)
2. SSI lower (OR 5.21 [95% CI 1.22-22.17], P = .025)
3. Cranioplasty explant lower (OR 4.70 [95% CI 1.10-20.05], P = .036)

NNT to prevent 1 cranioplasty infection = 24

Population / inclusion:

1. Malnutrition, pulmonary dysfunction / hypoxemia, neurological deficits, immunologic compromise, dehydration
2. All post-operative cranioplasty patients
   1. 15 years and older
   1. Primary cranioplasty after decompressive craniectomy for stroke, infection, trauma or cerebral edema related to hemorrhage of aneurysm or AVM
   1. More than 1 previous cranioplasty explant for infection excluded

REFERENCE:

Rae, A.I. et al. (2023) ‘Low-cost wound healing protocol reduces infection and reoperation rates after cranioplasty: A retrospective cohort study’, Neurosurgery, 93(6), pp. 1220–1227. doi:10.1227/neu.0000000000002563.