Background: Wound complications can occur in up to 20% of patients following multilevel posterior spinal fusion. Currently, the use of local flaps has been reported in high-risk patients with a history of spinal neoplasm, radiation therapy, exposed hardware, multiple spine surgeries, or wound infections. However, there are no reports of prophylactic muscle flap wound closure in patients undergoing multi-level spinal fusion for degenerative pathology. Given the extensive soft tissue dissection for exposure compounded by patient comorbidities, there is potential to minimize the risk of wound complications with prophylactic trapezius and/or paraspinal flap coverage. We sought to describe the utility and outcomes of prophylactic muscle flaps for wound coverage after instrumented posterior spinal fusion for multi-level degenerative spine disease and spinal deformity. Methods: An institutional review board (IRB)-approved retrospective review of 26 consecutive patients who underwent a multi-level posterior spinal fusion for degenerative pathology with concurrent muscle flap coverage at a single institution (August 2016 to February 2017) was done. Patient demographics, clinical profile, procedures, and outcomes at a minimum 6-month post-operatively have been described. Results: Patients had a mean age of 59.7±13.0 years with a mean body mass index (BMI) of 31.0±8.6 kg/m 2 .Paraspinous muscle flap (61.5%), trapezius (3.8%), and combination flaps (34.6%) were used for coverage of an average wound defect of 325 cm 2 extending over average 10.2 vertebral levels. All wounds healed completely with no complications at an average of 9.1 months follow-up. Only 1 patient (3.8%) developed a seroma for which interventional radiology (IR)-drainage was sufficient.Conclusions: Prophylactic trapezius and/or paraspinous muscle flap coverage using a team approach can reduce the risk of wound complications after extensive spinal fusion for multi-level degenerative disease or adult spinal deformity (ASD). Preliminary results from our institution suggest that routine use of such a protocol has the potential to improve quality of care and reduce healthcare expenditure associated with this relatively morbid procedure.
Introduction: We describe the treatment of rheumatoid radiocarpal joint and distal radioulnar joint (DRUJ) arthritis with radioscapholunate (RSL) arthrodesis and DRUJ arthroplasty in 2 patients with 2 years follow-up. The RSL arthrodesis utilizes nitinol staples and local distal radius autograft to fuse the scaphoid and lunate to the distal radius. Materials and Methods: One patient was treated in their nondominant extremity, and the other patient had bilateral procedures. A constrained endoprosthesis was used for the DRUJ arthroplasty portion, using the same dorsal approach to the wrist as the RSL arthrodesis. Results: Before his procedures, this first patient-reported a Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score of 66, which improved to 16 at 2 years postoperatively. He also reported a Visual Analog Scale score of 6/10 at rest in both wrists preoperatively. Following his procedures, Visual Analog Scale scores improved to 3/10 in the right wrist and 0/10 in the left wrist. Active wrist range of motion was measured to be a 60-degree arc on the right and a 47-degree arc on the left. Our second patient reported an improved QuickDASH score from 97 preoperatively to 68 at 2 years postoperatively and had a 70-degree arc of left wrist range of motion. No postoperative complications or reoperations were encountered in the cases. Discussion: The benefit of this technique is to allow simultaneous treatment of radiocarpal joint arthritis with RSL arthrodesis, permitting wrist flexion and extension through the midcarpal joints, and DRUJ arthritis with DRUJ arthroplasty, preserving pronation and supination.
Background: Digit amputations are relatively simple and are often performed in the setting of trauma or infection. However, it is not uncommon for digit amputations to undergo secondary revision due to complications or patient dissatisfaction. Identifying factors associated with secondary revision may alter treatment strategy. We hypothesize that the secondary revision rate is affected by digit, initial level of amputation, and comorbidities. Methods: A retrospective chart review was conducted on patients undergoing digit amputations in operating rooms at our institution from 2011 to 2017. Secondary revision amputations were defined as a separate return to the operating room following initial surgical amputation, excluding emergency room amputations. Patient demographics, comorbidities, level of amputation, and complications were collected. Results: In all, 278 patients were included with a total of 386 digit amputations and mean follow-up of 2.6 months. Three hundred twenty-six primary digit amputations were performed in 236 patients (group A). Sixty digits were secondarily revised in 42 patients (group B). The secondary revision rate was 17.8% for patients and 15.5% for digits. Patients with heart disease and diabetes mellitus were associated with secondary revision, with wound complications being the leading indication overall (73.8%). Medicare covered 52.4% of patients in group B versus 30.1% in group A ( P = .005). Conclusion: Risk factors for secondary revision include Medicare insurance, comorbidities, previous digit amputations, and initial amputation of either the index finger or the distal phalanx. These data may serve as a prediction model to aid surgical decision-making by identifying patients at risk of secondary revision amputation.
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