Muscle Flap Closures in Spine Surgery

Abstract

Study Design: Retrospective cohort study using the National Surgical Quality Improvement Program. Objective: The objective of this study was to identify preoperative factors that impact the decision to perform prophylactic muscle flap closure and assess risk factors for wound healing complications in patients undergoing spinal procedures with and without muscle flap closure. Summary of Background Data: Prior studies suggest that muscle flap closure following complex spine surgery results in a lower risk of wound healing complications. However, these studies have been limited to single institutions and/or surgeons. Methods: The National Surgical Quality Improvement Program database was queried for all patients undergoing spine surgery between 2005 and 2017 with and without concomitant muscle flaps. Preoperative and perioperative variables were extracted. Univariate and multivariate analyses were performed to assess risk factors influencing surgical site infection (SSI) and wound disruption, as well as to delineate which preoperative factors increased the likelihood of patients receiving flap closures a priori. Results: Concomitant muscle flaps were performed on 758 patients; 301,670 patients did not receive a flap. Overall 29 (3.83%) patients in the flap group experienced SSI compared to 5154 (1.71%) in the nonflap group (P<0.0001). Preoperative steroid use [odds ratio (OR) 0.5; P<0.0001], wound infection (OR 0.24; P<0.0001), elevated white blood cell count (OR 1.034; P<0.0001), low hematocrit (OR 0.94; P<0.0001), preoperative transfusion (OR 0.22; P=0.0068) were significantly associated with utilization of muscle flaps. Perioperative factors including a contaminated wound (OR 4.72; P<0.0001), the American Society of Anesthesiologists classification of severe disease (OR 1.92; P=0.024), and longer operative time (OR 1.001; P=0.0024) were significantly associated with postoperative wound disruption. In addition, after propensity score matching for these factors that increase risk of wound complications, there was no difference in the rates of SSI between the flap and nonflap group. Conclusion: Our results suggest that patients with a higher burden of illness preoperatively are more likely to receive prophylactic paraspinal flaps which can reduce the rates of wound-related complications.

Prophylactic Muscle Flaps in Patients with Oncologic Spine Disease Decrease Wound Complication Rates: A single institution cohort study

“…32 Traditionally, prophylactic MF use has been infrequent, with only a small number of spine surgery patients undergoing flap closure. 15 Typically, these patients have been more elderly, with higher degrees of systemic illness at the time of surgery. 15 However, the use of prophylactic MFs has become increasingly more common, especially in patients who present with complex systemic illness.…”

“…15 Typically, these patients have been more elderly, with higher degrees of systemic illness at the time of surgery. 15 However, the use of prophylactic MFs has become increasingly more common, especially in patients who present with complex systemic illness. Paraspinal MFs have an extremely low failure rate, and wound complications such as SSI, hematoma, and seroma can still occur.…”

“…In addition to underlying malignancy, risk factors for these complications include smoking, anemia, high body mass index (BMI), and chronic use of certain medications, including corticosteroids and opioids. [14][15][16] Each of these complications may result in a clinical course that is varied in both severity and treatment, including prolonged hospitalization and systemic antimicrobial therapy. 4,[17][18][19] Importantly, SSI and wound dehiscence are the most common reasons for reoperation after resection of spine metastases.…”

“…24,[30][31][32] A previous investigation of the National Surgical Quality Improvement Program database demonstrated that use of prophylactic MFs in patients with risk factors for poor wound healing may equalize the risk of postoperative wound complications to that of healthier patients. 15 However, this study did not specifically address patients with oncologic spine disease, who are exposed to additional wound healing risk factors such as chemotherapy and radiation therapy. Given the potential for improved wound healing with the use of prophylactic MF closures (MF closure group) in oncologic spine patients, we asked whether these patients experienced similar wound complications rates to those who undergo non-MF closure (non-MF closure group).…”

Pedicled Flaps for High-Risk Open Vascular Procedures of the Lower Extremity: An Analysis of The National Surgical Quality Improvement Project Database

“…2,3 In many nonvascular surgical populations, patients at high risk of implant exposure have been demonstrated to benefit from advanced closure methods such as muscle flaps. 4 This protective effect may be due to the multilayer closure, reduction in potential dead space, and decreased risk of fluid accumulation at the surgical site. 2,3 Nevertheless, the evidence for the use of enhanced closures in LE vascular procedures remains sparse and localized to single-center studies.…”