Background Scalp complications in craniofacial surgeries can increase morbidity and mortality. Given the inelastic characteristics of the scalp, these surgeries can be challenging, and multiple complications can arise. The literature on craniofacial surgery is extensive. However, few articles address scalp complications, associated factors, and prevention. This study aims to identify and classify scalp complications in craniofacial surgery and describe associated risk factors, general preventive measures, and an initial therapeutic approach. Methods We conducted a literature search in PubMed, Scopus, Cochrane Library, and LILACS to review the scalp complications in craniofacial surgery. The studies selected included retrospective case series, narrative reviews, systematic reviews, and cadaveric anatomic studies. We completed the search with book chapters and specific topic reviews. Results We screened a total of 124 sources and selected 35 items for inclusion in this review. Based on the updated review, we categorized scalp complications into wound defects, soft tissue contour irregularities, neurovascular defects, and infection. We discuss the main characteristics, risk factors, preventive measures, and initial management of these complications. Conclusions For craniofacial surgery, understanding the surgical anatomy, identifying risk factors, adequate surgical planning, and interdisciplinary cooperation between neurosurgeons, plastic surgeons, and the interdisciplinary team are essential to prevent and treat scalp complications. Level of evidence: Not ratable

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Multiple tissue perfusion markers are described to guide therapy in critically ill pediatric patients undergoing congenital heart surgery. Given the advantages of capillary refill time, our goal is to determine its predictive capacity for mortality and postoperative extracorporeal oxygenation requirements in congenital heart surgery and compare it to serum lactate. We conducted a prospective cohort observational study in a single high-complexity university hospital. Serum lactate and capillary refill time were measured at five predetermined time points: preoperative, immediate postoperative, 6, 12, and 24 h after the surgery. Prolonged immediate postoperative, 6 h, and 12 h capillary refill time measurements turned out to be independent risk factors for both outcomes. The capillary refill time area under the curve ranged between 0.70 and 0.80, while the serum lactate resulted between 0.79 and 0.92 for both outcomes. Both tissue perfusion markers resulted in mortality and extracorporeal oxygenation requirement predictors. Given the advantages of capillary refill time over serum lactate, a monitoring strategy including these two perfusion markers should be considered for congenital heart surgeries.

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