Rotational and transpositional flaps for the treatment of spinal wound dehiscence and infections in patient populations with degenerative and oncological disease

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> Wound-related complications following complex posterior spine procedures may result in the need for serial debridements and may place the instrumentation at risk. Numerous treatments have been advocated for this problem, but each has limitations. In this article the authors discuss the experience from two large teaching institutions at which rotational and transpositional flaps were used in the management of deep wound infections and dehiscences.</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> The authors generated a list of patients treated via posterior or posterolateral approaches for metastatic tumors or complex degenerative disorders in whom wound complications subsequently developed. Data were obtained from the medical records and reviewed retrospectively.</jats:p> <jats:p content-type="fine-print">Thirty-seven patients were treated with rotational or transpositional flaps at the two institutions during the study period. Patients underwent a mean of 1.3 procedures for the treatment of wound healing problems, and cultures were positive in 70%. In three patients (8%) this treatment failed due to protrusion of hardware through the skin or repeated dehiscence requiring reclosure. Spinal instrumentation was salvaged in 97% of the cases.</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> The use of local tissue flaps is advantageous for treatment of posterior wound complications due to spine surgery. In this procedure highly vascularized tissue is used to increase healing, accelerate clearance of bacteria, and fill any dead space.</jats:p>

Spinal extradural arachnoid cyst following percutaneous vertebroplasty

“…Because of their immunocompromised [17,30,33,34]. For these patients with limited life expectancies, the appropriate treatment is to achieve relief of pain and to regain function, thus improving the quality of the life as quickly as possible.…”

Wound conditioning by vacuum assisted closure (V.A.C.) in postoperative infections after dorsal spine surgery

“…The flap coverage is the standard treatment of infected wounds after spine surgery [9,14,15,27,32,41,45,46,63,66]. The use of omental transposition in the treatment of recurrent sarcoma of the back was also described [38].…”

“…Recently, some authors showed that instrumentation salvage is possible when techniques such as serial debridements, antibiotic medication, irrigation-suction systems and delayed primary closure of the wound are used [39,42,51,54,59,60,65]. Primary or delayed primary closure is often not possible and muscle flaps are required to close the dead space and to provide soft tissue coverage [15,27,46,63]. The muscle flaps, however, as extensive surgical procedures bear a significant morbidity for these critically ill patients [61,69].…”

CT-Guidance Interstitial 125iodine Seed Brachytherapy as a Salvage Therapy for Recurrent Spinal Primary Tumors

“…The dose tolerance for organs at risk could be better contoured. Vitaz et al reported that prior adjuvant treatment modalities such as chemotherapy or EBRT typically increase perioperative morbidity and mortality following spinal surgery [18]. The best surgical outcomes are achieved with radical resection of the tumor (removal of the whole spine) [19].…”