Optimizing Successful Outcomes In Complex Spine Reconstruction Using Local Muscle Flaps
Leslie E. Cohen, MD, Natalia Fullerton, MD, Andrew Weinstein, MD, Lily R. Mundy, BS, Jill J. Ketner, PA, Kai-Ming Fu, MD, Roger Hartl, MD, Jason A. Spector, MD.
New York Presbyterian Weill Cornell, New York, NY, USA.
Post-operative wound complications in patients undergoing spinal surgery can have devastating effects including hardware exposure, meningitis, and result in unplanned re-operation. The literature shows that wound complication rates in this population approach upwards of 20% and in “high-risk” patients (prior spinal surgery, existing spinal wound infection, cerebral spinal fluid (CSF) leak, or history of radiation) as high as 50% with re-operation rates at 12%. We aimed to investigate if prophylactically closing spinal wounds with muscle flaps improves outcomes.
A retrospective review was performed of 105 patients who underwent spinal wound closure via paraspinous, trapezius, or latissimus muscle advancement flaps by a single plastic surgeon from 2006 to 2014. Data regarding pre-surgical diagnosis, patient demographics and incidence of post-operative complications was recorded.
105 flaps were included with follow up ranging from 2-60 months. 91 cases were classified as “high-risk” for wound complications, defined as those having prior spinal surgery, existing spinal wound infection, CSF leak, or prior radiation. Of the 91 closures, there was an 8.8% wound complication rate, 3 of whom had infections pre-operatively, with only a 5.5% re-operation rate.
In this study there is a markedly lower rate (8.8%) of post-operative wound complications compared to historical controls after closure of spinal wounds with local muscle flaps in high risk patients. These data encourage safe and routine use of muscle flap closures on high risk patients undergoing spinal surgery with the aim to prevent postoperative wound complications, increase hardware salvage rates and lower re-operation rates.
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