Paraspinous Muscle Flap Reconstruction of Complex Midline Back Wounds

Mericli, Alexander F.; Tarola, Nicolas; Moore, J. H.; Copit, Steven E.; Fox, James W.; Tuma, Gary A.

doi:10.1097/sap.0b013e3181c47ef4

Cited by 48 publications

(61 citation statements)

References 33 publications

(24 reference statements)

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“…Our PubMed search yielded 532 articles for screening, and, with the application of our inclusion criteria, we narrowed down the results to 17 articles (3 case reports, 8,14,21 5 case series, 4,9,16,20,30 and 9 retrospective studies 7,10,13,17,[24][25][26]28,32 ). The detailed study selection flowchart is shown in Fig.…”

Section: Results Search Resultsmentioning

confidence: 99%

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Reconstruction of open wounds as a complication of spinal surgery with flaps: a systematic review

Chieng

Hubbard

Salgado³

et al. 2015

FOC

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OBJECT A systematic review of the available evidence on the prophylactic and therapeutic use of flaps for the coverage of complex spinal soft-tissue defects was performed to determine if the use of flaps reduces postoperative complications and improves patient outcomes. METHODS A PubMed database search was performed to identify English-language articles published between 1990 and 2014 that contained the following phrases to describe postoperative wounds (“wound,” “complex back wound,” “postoperative wound,” “spine surgery”) and intervention (“flap closure,” “flap coverage,” “soft tissue reconstruction,” “muscle flap”). RESULTS In total, 532 articles were reviewed with 17 articles meeting the inclusion criteria of this study. The risk factors from the pooled analysis of 262 patients for the development of postoperative complex back wounds that necessitated muscle flap coverage included the involvement of instrumentation (77.6%), a previous history of radiotherapy (33.2%), smoking (20.6%), and diabetes mellitus (17.2%). In patients with instrumentation, prophylactic coverage of the wound with a well-vascularized flap was shown to result in a lower incidence of wound complications. One study showed a statistically significant decrease in complications compared with patients where prophylactic coverage was not performed (20% vs 45%). The indications for flap coverage after onset of wound complications included hardware exposure, wound infection, dehiscence, seroma, and hematoma. Flap coverage was shown to decrease the number of surgical debridements needed and also salvage hardware, with the rate of hardware removal after flap coverage ranging from 0% to 41.9% in 4 studies. CONCLUSIONS Prophylactic coverage with flaps in high-risk patients undergoing spine surgery reduces complications, while therapeutic coverage following wound complications allows the salvage of hardware in the majority of patients.

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Section: Results Search Resultsmentioning

confidence: 99%

“…7,13,17,25 A total of 262 patients were pooled to analyze the overall breakdown of various potential contributing factors. The greatest potential factor was involvement of instrumentation (77.6%).…”

Section: Risk Factors For the Development Of Postoperative Woundsmentioning

confidence: 99%

Reconstruction of open wounds as a complication of spinal surgery with flaps: a systematic review

Chieng

Hubbard

Salgado³

et al. 2015

FOC

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“…2 Other muscles such as paraspinal muscles and gluteus muscle flaps can be used to reconstruct the lower back. 3 However, large defects often require multiple local muscle flaps to achieve adequate coverage, and risks in increased possibility for donor site morbidity. 2,4 Free flaps may be inevitable for extensive defects but finding adequate recipient vessels remains to be challenging and alternative methods, such as arteriovenous looping and interposition grafts may increase the risk for complication.…”

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confidence: 99%

Freestyle Propeller Flaps to Reconstruct Defects of the Posterior Trunk

Hallock²,

Hong³

2012

Annals of Plastic Surgery

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The reconstruction of complex defects of the back remains difficult. However, a local skin flap alone based on a competent single perforator can have a large skin territory with an efficient arc of rotation as a propeller flap to cover many back wounds, while the donor site can still be closed primarily. Eleven patients with defect sizes ranging from 36 to 264 cm(2) underwent coverage of posterior trunk defects using propeller flap (rotated perforator flaps), and all the donor sites were primarily closed. The average number of perforators within the flap was 1.4. All flaps healed uneventfully except for 1 case in which congestion was noted; leech was applied and the flap healed well. Radiation therapy was done in 1 case and was uneventful. The freestyle perforator propeller flap can be a reliable and a simpler solution to reconstruct a difficult defect while achieving minimal donor site morbidity.

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“…Except for the thoracolumbar area in the patient with MMC, the monofilament test showed a threshold of 3.61 in all reconstructed areas, indicating that protective sensibility was obtained in these areas. The average hospital stay after wound closure was 10 days (range [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. During the follow-up period (mean 65 mo, range 7-106) 1 patient developed an infection in the operated area 81 months postoperatively.…”

Section: Resultsmentioning

confidence: 99%

“…Mericli et al showed in a large series of patients that the removal of the instrumentation may actually impede healing in the reconstructed area. 15 In all patients except the 1 with cancer, the wounds were treated with VAC after debridement until the results of bone cultures were known. The VAC system has been reported to be an effective adjunct in wound conditioning and closure of these complex wounds.…”

Section: Discussionmentioning

confidence: 99%