Background: Cranial surgical site infection is a significant cause of morbidity and mortality in hospitals. Preoperative hair shaving for cranial neurosurgical procedures is performed traditionally in an attempt to protect patients against complications from infections at cranial surgical sites. However, preoperative shaving of surgical incision sites using traditional surgical blades without properly washing the head after surgery can cause infections at surgical sites. Therefore, a rapid protocol in which the scalp remains unshaven and absorbable sutures are used for scalp closure with early postoperative shampooing is examined in this study. Methods: A retrospective comparative study was conducted from January 2008 to December 2012. A total of 2,641 patients who underwent unshaven cranial surgery with absorbable sutures for scalp closure were enrolled in this study. Data of 1,882 patients who underwent surgery with the traditional protocol from January 2005 to December 2007 were also analyzed for comparison. Results: Of 2,641 patients who underwent cranial surgery with the rapid protocol, all but 2 (0.07%) patients experienced satisfactory wound healing. Of 1,882 patients who underwent cranial surgery with the traditional protocol, 3 patients (0.15%) had infections. Each infection occurred at the superficial incisional surgical site. Conclusion: Unshaven cranial surgery using absorbable sutures for scalp closure with early postoperative shampooing is safe and effective in the cranial neurosurgery setting. This protocol has a positive psychological effect. It can help patients accept neurosurgical procedures and improve their self-image after the operation.

McClelland S, Hall W: Postoperative central nervous system infection: incidence and associated factors in 2,111 neurosurgical procedures. Clin Infect Dis 2007;45:55-59.
Braun V, Richter HP: Shaving the hair - is it always necessary for cranial neurosurgical procedures? Acta Neurochair 1995;135:84-86.
Gil Z, Cohen JT, Spektor S, Fliss DM: The role of hair shaving in skull base surgery. Otolaryngol Head Neck Surg 2003;128:43-47.
Kjonniksen I, Andersen BM, Sondenaa VG, Segadal L: Preoperative hair removal - a systematic literature review. AORN J 2002;75:928-938.
Alexander JW, Fischer JE, Boyajian M, Palmquist J, Morris MJ: The influence of hair removal methods on wound infections. Arch Surg 1983;11:347-352.
Cronquist AB, Jakob K, Lai L, et al: Relationship between skin microbial counts and surgical site infection after neurosurgery. Clin Infect Dis 2001;33:1302-1308.
Morace R: Absorbable intradermal closure of elective craniotomy wounds. Oper Neurosurg 2008;2:490-492.
Adeleye AO, Olowookere KG: Nonshaved cranial surgery in black Africans: a short-term prospective preliminary study. Surg Neurol 2008;69:69-72.
Iwami K, Takagi T, Arima T, Takayasu M: Cranial surgery without hair shaving: practice and results in our hospital. No Shinkei Geka 2006;54:886-888.
Ratanalert S, Saehaeng S, Sripairojkul B, Liewchanpattana K, Phuenpathom N: Nonshaved cranial neurosurgery. Surg Neurol 1999;51:458-463.
Sheinberg MA, Ross DA: Cranial procedures without hair removal. Neurosurgery 1999;44:1263-1266.
Amylcar ED, Silvio M, José IM, Daniel SS, Fábio P, Arnaldo DR: Craniotomy without trichotomy: analysis of 640 cases. Amos Olufemi Adeleye Arq Neuropsiquiatr 2004;28:103-107.
Kretschmer T, Nraun V, Richter HP: Neurosurgery without shaving: indications and results. Br J Neurosurg 2000;14:341-344.
Bekar A, Korfali E, Dogan S, Yilmazlar S, Baskan Z, Aksoy K: The effect of hair removal on infection after cranial surgery. Acta Neurochir 2001;143:533-536, discussion 573.
Miller JJ, Weber PC, Patel S, Ramey J: Interacranial surgery: to shave or not to shave? Otol Neurotol 2001;43:814-820.
Tanner J, Woodings D, Moncaster K: Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev 2006;3:CD004122.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR: Guideline for prevention of surgical site infection. Am J Infect Control 1999;27:97-134.
Camarata JC, Wang PT: Hair sparing techniques and scalp flap design. Neurosurg Clin N Am 2002;13:411-419.
Winston KR: Hair and neurosurgery. Neurosurgery 1992;31:320-329.
Piatt JH, Steinbok P: Hair and neurosurgery. Neurosurgery 1994;34:770.
Hwang SC, Kim SK, Park KW, et al: Outpatient-based scalp surgery without shaving and allowing use of shampoo. World Neurosurg 2012;77:391-393.
Zentner J, Gilsbach J, Daschner F: Incidence of wound infection in patients undergoing craniotomy: influence of type of shaving. Acta Neurochir 1987;88:79-82.
Celik SE, Kara A: Does shaving the incision site increase the infection rate after spinal surgery? Spine 2007;32:1575-1577.
Sebastian S: Does preoperative scalp shaving result in fewer postoperative wound infections when compared with no scalp shaving? A systematic review. J Neurosci Nurs 2012;44:149-156.
Siddique MS, Matai V, Sutcliffe JC: The preoperative skin shave in neurosurgery: is it justified? Br J Neurosurg 1998;12:131-135.
Beldi G, Bisch-Knaden S, Banz V, Muhlemann K, Candinas D: Impact of intraoperative behavior on surgical site infections. Am J Surg 2009;198:157-162.
Palese A, Moreale R, Noacco M, Pistrino F, Mastrolia I, Sartor A, Scarparo C, Skrap M: Post-operative shampoo effects in neurosurgical patients: a pilot experimental study. Surg Infect 2015;16:133-138.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.