Reconstruction of open wounds as a complication of spinal surgery with flaps: a systematic review

Chieng, Lee Onn; Hubbard, Zachary; Salgado, Christopher J.; Levi, Allan D.; Chim, Harvey

doi:10.3171/2015.7.focus15245

Cited by 46 publications

(44 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our hands, soft tissue defects of the posterior trunk or spinal area can be successfully treated using paraspinal perforator flaps with low donor site morbidity. In our retrospective study including 20 patients, we observed a similar complication rate in paraspinal perforator flaps compared to muscle flap coverage (14). From our experience, complete dissection of perforators should be minimized in flap rotation is less than 90˚.…”

Section: Discussionsupporting

confidence: 53%

“…In our series, we exclusively performed delayed defect restoration. Most recent articles propose prophylactic (immediate) wound coverage with well-vascularized tissue in high-risk patients, to decrease the incidence of postoperative wound healing complications after spinal surgery (4,14). In published studies regarding benefits of immediate reconstruction, mostly muscle flaps were used for defect closure (4,18,26).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Reconstruction of Spinal Soft Tissue Defects With Perforator Flaps From the Paraspinal Region

Summa¹,

Largo²,

Ismail³

et al. 2019

In Vivo

View full text Add to dashboard Cite

Background/Aim: Reconstruction of spinal soft tissue defects is challenging, especially when neural structures or prosthetic material are exposed. They should be covered with well-vascularized tissue such as paraspinal perforator flaps. Materials and Methods: This is a retrospective study of soft tissue reconstructions with paraspinal perforator flaps from 2011 to 2018. The technique is described and risk factors for poor wound healing were assessed. Postoperative complications are reported. Results: Twenty patients with a mean age of 63.65 years were included. Defects had an average size of 47 cm 2 and were mainly located in the lumbosacral region (9 patients). Twelve patients suffered from infection following spinal stabilization, seven of whom were diagnosed with osteomyelitis, two patients presented with pressure sore and one patient experienced wound dehiscence. One partial flap necrosis with a lumbar defect occurred, which required revision surgery. No total flap loss occurred. Stable, closed wounds were achieved at their final follow-up. Conclusion: Perforator paraspinal flaps are suitable for immediate reconstruction of spinal defects.

show abstract

Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Reconstruction of Spinal Soft Tissue Defects With Perforator Flaps From the Paraspinal Region

Summa¹,

Largo²,

Ismail³

et al. 2019

In Vivo

View full text Add to dashboard Cite

show abstract

“…14 In patients undergoing extensive spinal tumor resection, wound complications can be particularly devastating because of the risk of exposed hardware or neural structures. Subsequent reoperations and washouts potentiate the risk for hardware removal, which can cause long-term deformity and neural injury.…”

Section: Discussionmentioning

confidence: 99%

Surgical Factors Associated with Prolonged Hospitalization after Reconstruction for Oncological Spine Surgery

Carl

Coon

Calotta

et al. 2017

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

Background:Posterior trunk reconstruction is increasingly possible as a result of advances in spinal instrumentation, reconstructive approaches, and perioperative critical care. Extensive cases often require a muscle flap or complex closure to obliterate dead space. Postsurgical wound complications and subsequent reoperations can lead to neural injury, higher hospital costs, and longer hospitalizations. We aim to identify risk factors that are associated with increased length of stay (LOS) for patients receiving flaps to close a spinal defect.Methods:A single institution, retrospective cohort study was performed on all patients from 2002 to 2014 who received a muscle flap to close a spine defect. Medical and perioperative variables that were significantly associated with LOS (P < 0.05) in univariate analysis were included in a stepwise regression model.Results:A total of 288 cases were identified. Presence of instrumentation, preoperative chemotherapy, wound dehiscence, cerebrospinal fluid leak, partial/total flap loss, and medical morbidity occurrence were all independently associated with increased LOS in a combined multivariate model (P < 0.02 for each of the 6 variables). Importantly, Kaplan–Meier analysis demonstrated that postoperative wound dehiscence increased LOS by 12 days.Conclusions:Spinal tumor resections often create large cavitary defects that necessitate the use of muscle flaps for closure. Patients who have received adjuvant chemotherapy require instrumentation, or those who develop specific wound-related or medical complications are at increased risk for prolonged hospitalization after spinal reconstruction. Thus, implementing measures to mitigate the occurrence of these adverse events will reduce costs and decrease the length of hospitalization.

show abstract

“…Reconstruction of complex back defects, especially following spinal surgery, presents a variety of challenges for the reconstructive surgeon, and such cases may be additionally complicated by previous surgeries, planned instrumentation, and altered anatomy. Furthermore, patients undergoing spinal surgery and subsequent reconstruction are subject to a multitude of postoperative complications, including infection, wound‐dehiscence, seroma, hematoma, hardware exposure, and cerebrospinal fluid leak (Chieng et al, ; Rozen et al, ; Saint‐Cyr et al, ). However, it has been shown that adequate coverage of posterior trunk defects with robust muscle flaps both decreased postreconstructive complication rates, and provide strategies for the salvage of infected hardware (Cohen et al, ; Dumanian et al, ; Hultman et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…Reconstruction of complex back defects, especially after corrective spine surgery, poses a demanding problem for both the patient and the reconstructive surgeon. Complications such as infection, wound‐dehiscence, seroma, hematoma, and hardware exposure have been reported with rates between 6% and 30% in such patients (Chieng, Hubbard, Salgado, Levi, & Chim, ; Cohen et al, ; Mericli et al, ). Furthermore, particular subunits of the back present even greater reconstructive challenges, specifically the central region between T9 and T12.…”

Section: Introductionmentioning

confidence: 99%

A new propeller trapezius muscle flap for reconstruction of posterior trunk defects: An anatomic study and report of three cases

et al. 2018

View full text Add to dashboard Cite

Background Reconstruction of complex back defects, especially after corrective spine surgery, is a challenging problem. In these patients hardware issues predominate and flap failure has serious consequences. Certain subunits of the back pose even greater problems, specifically the central region between T9 and T12. The purpose of this article is to present a novel technique for reconstruction of such spinal defects using a newly described trapezius muscle propeller flap based on the dorsal scapular vessels. Methods Four cadaveric trapezius muscle propeller flaps were raised to ensure appropriate rotation into central region of the posterior trunk between T9 and T12. Three patients all had similar presentations with a history of scoliosis, previous failed spinal instrumentation, prominent hardware, impending exposure, worsening kyphosis, and back pain. The patients underwent planned extension fusions from the upper thoracic to lumbar vertebrae by orthopedic surgery. All three patients lacked local reconstructive options and propeller trapezius muscle flaps were dissected. Results All cadaveric dissections demonstrated adequate rotation of the muscle flap without tension or kinking of the vascular pedicle. For the case studies, two patients had right sided trapezius flaps utilized, one patient had injury to the right dorsal scapular vessels during dissection, thus a left sided trapezius was rotated. One patient had complications including a seroma requiring aspiration and superficial wound breakdown. All had complete healing with no postoperative shoulder dysfunction noted. Conclusion As a result, the trapezius muscle propeller flap is found to be a novel flap that provides a simple, yet robust solution to an otherwise difficult reconstructive problem.

show abstract

Reconstruction of open wounds as a complication of spinal surgery with flaps: a systematic review

Cited by 46 publications

References 35 publications

Reconstruction of Spinal Soft Tissue Defects With Perforator Flaps From the Paraspinal Region

Reconstruction of Spinal Soft Tissue Defects With Perforator Flaps From the Paraspinal Region

Surgical Factors Associated with Prolonged Hospitalization after Reconstruction for Oncological Spine Surgery

A new propeller trapezius muscle flap for reconstruction of posterior trunk defects: An anatomic study and report of three cases

Contact Info

Product

Resources

About