Muscle and Musculocutaneous Flap Coverage of Exposed Spinal Fusion Devices

Hochberg, Júlio; Ardenghy, Marcos; Yuen, James C.; Gonzalez-Cruz, Roberto; Miura, Yukiko; Rm, Conrado; Tg, Pait

doi:10.1097/00006534-199808000-00013

Cited by 61 publications

(35 citation statements)

References 6 publications

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“…Such wounds, especially when associated with exposed hardware represent a significant situation which may lead to spinal instability, inability to achieve erect posture, and neurological compromise. Moreover, the morbidity associated with complicated [5,16,29,30,31].…”

Section: Discussionmentioning

confidence: 99%

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Immediate debridement and coverage of exposed spinal hardware with muscle flaps

Akyürek

Şafak

Alanay

et al. 2002

European Journal of Plastic Surgery

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We report the outcome of immediate débride-ment and soft tissue cover of spinal wounds secondary to exposure of orthopedic hardware, using local muscle or musculocutaneous flaps. Five patients were treated (mean age 18 years). Radical débridement was performed prior to flap closure. Depending on the location of the defect, a pedicled muscle or myocutaneous flap was selected, alone or in combination with latissimus dorsi, trapezius, gluteus maximus, or paraspinous muscles. The implants were successfully covered. The hardware was maintained until solid spinal fusion was achieved. We recommend early and definitive cover of exposed spinal fusion devices using local muscle or musculocutaneous flaps; the choice depends on the location of the defect. By this approach the wound can be effectively repaired with a well-vascularized muscle flap covering the hardware, thus obviating the need for its removal and thus ensuring spinal stability.

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Section: Discussionmentioning

confidence: 99%

“…However, such a conventional treatment for these infections is not always successful in achieving delayed primary wound closure. Therefore muscle or musculocutaneous flaps are necessary to accomplish early wound closure, and cover the exposed metalwork, thereby ensuring spinal stability [5,16,25,29,30,31].…”

Section: Introductionmentioning

confidence: 99%

Immediate debridement and coverage of exposed spinal hardware with muscle flaps

Akyürek

Şafak

Alanay

et al. 2002

European Journal of Plastic Surgery

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“…Literaturangaben über exponierte Ellenbogen- [19] oder Tumorendoprothesen [32] beschränken sich auf wenige Fallberichte mit zumeist erfolgreichem Metallerhalt. Nach Wirbelsäuleneingriffen wird das einliegende Metall bei Exposition nur selten (0-12%) entfernt [15,27,51]. An der unteren Extremität hingegen wurde in einer Studie von Gault …”

Section: Materials Und Methodenunclassified

“…Levasoy et al definieren eine Infektion erst durch das Auftreten von Eiter, ein Infekt ohne Eiter wird als "Kontamination" bezeichnet [32]. Hochberg und Mitarbeiter definieren einen alleinigen positiven Wundabstrich ebenfalls als Kontamination [27], während andere Autoren von Infektion berichten [1,20]. Weiterhin wird zwischen "früher" und "später" sowie "oberflächlicher" und "tiefer" Infektion unterschieden: Die Grenze zwischen "früher" und "später" Infektion wird in der Regel bei 3-4 Wochen festgelegt [14,23,25,38,41,43,52].…”

Section: Infektionunclassified

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Weichteildefekt und exponiertes Osteosynthesematerial — Metallerhalt oder Entfernung?

Baumeister

Levin

Erdmann

2006

Chirurg

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Hardware used in spine surgery is commonly left in situ until bony consolidation has been achieved. The indications for hardware removal depend on length of exposure or infection, implant failure, and location. Osteosynthetic devices in the extremities may be removed and replaced by external fixators or immobilisation. Removal of prostheses requires complex second-stage reimplantation or arthrodesis. A treatment algorithm is suggested that might ease the decision whether exposed hardware can remain or requires removal before reconstruction of soft-tissue defects.

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Distally based saphenous neurocutaneous perforator flap combined with vac therapy for soft tissue reconstruction and hardware salvage in the lower extremities

et al. 2013

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The complex wound with the exposed hardware and infection is one of the common complications after the internal fixation of the tibia fracture. The salvage of hardware and reconstruction of soft tissue defect remain challenging. In this report, we presented our experience on the use of the distally based saphenous neurocutaneous perforator flap combined with vacuum-assisted closure (VAC) therapy for the coverage of the soft tissue defect and the exposed hardware in the lower extremity with fracture. Between January 2008 and July 2010, seven patients underwent the VAC therapy followed by transferring a reversed saphenous neurocutaneous perforator flap for reconstruction of the wound with exposed hardware around the distal tibia. The sizes of the flaps ranged from 6 × 3 cm to 15 × 6 cm. Six flaps survived completely. Partial necrosis occurred in one patient. There were no other complications of repair and donor sites. Bone healing was achieved in all patients. In conclusion, the reversed saphenous neurocutaneous perfortor flaps combined with the VAC therapy might be one of the options to cover the complex wound with exposed hardware in the lower extremities.

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Muscle and Musculocutaneous Flap Coverage of Exposed Spinal Fusion Devices

Cited by 61 publications

References 6 publications

Immediate debridement and coverage of exposed spinal hardware with muscle flaps

Immediate debridement and coverage of exposed spinal hardware with muscle flaps

Weichteildefekt und exponiertes Osteosynthesematerial — Metallerhalt oder Entfernung?

Distally based saphenous neurocutaneous perforator flap combined with vac therapy for soft tissue reconstruction and hardware salvage in the lower extremities

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