EP455 IMPROVING HEALING OF COMPLICATED PEDIATRIC NEUROSURGICAL WOUNDS WITH SURGICAL DEBRIDEMENT AND HYPERICUM AND NEEM OIL SPRAY.

Aim: Surgical wounds in major neurosurgery operations are at high risk of breakdown. Firstly, surgical incision is wide and implies section of vascular peduncle/s, impairing skin flap blood supply. Secondly, subcutaneous tissue is thin, particularly in infants. Finally, wound margins coagulation and removal of pericranium represent other risk factors. An oil spray mainly composed by hypericum and neem oil exerts an anti-inflammatory, immunomodulatory and antimicrobic action which promotes wound healing process. We present a case in which the use of oil spray and physical debridement allowed excellent healing of a compromised wound. Method: We present the case of a 7-year-old girl affected from Chiari malformation. She underwent posterior fossa decompression with duroplasty performed using pericranium harvested from occipital region. Since postoperative day 1, wound margins started to show a necrotic area. The wound was disinfected with a non-alcoholic product and sterile saline solution. Necrotic tissues were physically removed. Subsequently, the oil spray was applied. Results: The whole healing process took almost 2 months (Figure 1). There was no hospital discharge delay. Once a week the child was brought to the outpatient clinic to check the wound healing. Stiches were removed on postoperative day 14 and no cerebrospinal fluid leak was observed. Conclusion: The wound healing process derives from the mutually enhancing effect of surgical debridement and of oil spray, which promotes reactivation of microcirculation at wound margins and maintenance of a clean wound floor, helping controlling local inflammation. This was encountered in other pediatric cases in our hospital and reduces hospital costs. We conclude that complicated surgical wounds can be effectively treated with debridement and regular application of oil spray. [ABSTRACT FROM AUTHOR]