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

Abstract

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.

Coverage of Midline Back Wounds with Perforator-Based Pedicled Fasciocutaneous Flaps

“…In other studies which used similar methods, the rates of postoperative minor complications were 5.25%-19.1%. However, major complications of total flap necrosis did not occur in our study, while in other studies there were major complications (1.5%-5%) [6,13]. In our study, the etiology of the wound was mainly spinal surgery and paraplegia (92.3%), in contrast to other studies (50%-70%).…”

“…Recently the perforator flap has been used more frequently in back reconstruction [2]. In addition to the paraspinal muscle flap or free flap, the perforator-based pedicled flap has been used in midline back reconstruction [6].…”

“…The limitations of this study are as follows: there were less cases included than of those in recent reports on back and midline back reconstruction using perforator flaps [6,13]. Cases with very large wound (wider than 8 cm) coverage were not included.…”

Reconstruction of soft tissue defects caused by spinal surgery using a dorsal intercostal artery perforator flap

“…Spinal soft tissue defects resulting from spinal surgery complications are a major concern for reconstructive surgeons since they are difficult to reconstruct due to the low degree of vascularity in the area, strong skin tension, lack of tissue, and the curved contour of the back [1].…”