Muscle Flap Closure following Complex Spine Surgery: A Decade of Experience

Abstract

Background: Advances in surgical technology and adjuvant therapies along with an aging and increasingly morbid U.S. population have led to an increase in complex spine surgery. With this increase comes an elevated risk of complications, including those related to the surgical wound, with some studies demonstrating wound complication incidences approaching 45 percent. The authors hypothesize that immediate muscle flap closure improves outcomes in high-risk patients. Methods: Three hundred one consecutive index cases of spinal wound closure using local muscle flaps performed by the senior author at a single institution between 2006 and 2018 were reviewed. The primary outcome was major wound complication (reoperation and/or readmission because of surgical-site infection, late infection, dehiscence, seroma, or hematoma). Logistic regression analysis was performed to identify predictors of this endpoint. Results: Major wound complications occurred in 6.6 percent of patients (reoperation, 3.6 percent; readmission, 3.0 percent), with a 6.0 percent infection rate and five cases requiring instrumentation removal because of infection. Risk factors identified included radiotherapy (OR, 5.9; p = 0.004), age 65 years or older (OR, 2.8; p = 0.046), and prior spine surgery (OR, 4.3; p = 0.027). The incidence of major wound complication increased dramatically with each additional risk factor. Mean drain dwell duration was 21.1 ± 10.0 days and not associated with major wound complications, including infection (OR, 1.04; p = 0.112). Conclusions: Immediate local muscle flap closure following complex spine surgery on high-risk patients is associated with an acceptable rate of wound complications and, as these data demonstrate, is safe and effective. Consideration should be given to immediate muscle flap closure in appropriately selected patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Paraspinous Muscle Flaps in Complex Pediatric Spine Surgeries

“…Prior published studies have suggested stratifying patients' risk factors and offering plastic surgery reconstruction for those in higher risk categories as a potential management strategy, given that not every patient who undergoes spine surgery may receive additional benefit from plastic surgery involvement 11,28 . Wright et al 28 reviewed a single institution's experience with muscle flap closure for spine surgery and found that the highest-risk patients, such as those with a history of radiotherapy and prior spine surgery, had increased major wound complications, concluding that these patients would benefit from plastic surgery closure. Another study found that history of radiotherapy, smoking, and diabetes are associated with developing complex spinal wounds and that prophylactic flap coverage helped to lower the incidence of wound complications 13 .…”

Plastic multilayered closure versus orthopedic surgeon closure after spinal instrumentation in pediatric neuromuscular scoliosis

“…PMC for spinal wounds have been described in the literature. In 2022, Wright et al 15 described a series of 301 patients (76% having comorbidities) undergoing muscle flap closure with a major wound complication rate of 20%. In 2015, Cohen et al 16 described 102 PMCs reconstructions in 96 patients (86% classified as high risk) with a markedly low major wound complication rate of 6% and overall wound complication rate of 10%.…”

Comparison of Plastic Surgeon and Spine Surgeon Closure in Revision Short Segment Thoracolumbar Spinal Fusions

“…Revision surgery was cited as a common indication to perform a flap closure at that study institution 12 . Wright et al 17 reviewed 300 spines fused on average of 4.6 levels and closed by a single plastic surgeon using local muscle flaps, and they identified prior spine surgery both as the most common indication of muscle flap closure and as a major risk factor for wound complications.…”