Paravertebral Turnover Flaps for Closure of Large Spinal Defects Following Tethered Cord Repair

Arad, Ehud; Barnea, Yoav; Gur, Eyal; Amir, Aharon; Leshem, David; Zaretski, Arik; Rochkind, Shimon; Beny, Liana; Constantini, Shlomi; Weiss, Jerry

doi:10.1097/01.sap.0000235424.26158.e5

Cited by 11 publications

(8 citation statements)

References 21 publications

(40 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Other studies have proven the effectiveness of layered closures in reducing the infection rate in nonidiopathic spine fusions [18]. Layered closure has also been shown to reduce infection of tethered cord repairs [19][20][21]. This study also supports the concept that layered closure may have a prophylactic effect against deep infection.…”

Section: Discussionsupporting

confidence: 61%

Offset layered closure reduces deep wound infection in early-onset scoliosis surgery

Grzywna

Miller

Glotzbecker

et al. 2016

Journal of Pediatric Orthopaedics B

View full text Add to dashboard Cite

Deep wound infection is a common complication in early-onset scoliosis (EOS) surgery. Soft tissue technique has received less attention as a means to reduce infection. A retrospective review of 1170 EOS surgeries (single surgeon, institution) investigated the impact of offset layered closure (OLC) and soft tissue awareness. The introduction of OLC reduced deep infection from 3.0% in 99 surgeries to 0.37% in 1071. Logistic regression confirmed that OLC led to significantly lower odds of infection (P=0.007). This deep infection rate (0.37%) is more typical of elective surgery, providing a more optimistic view of infection in EOS surgery than generally reported.

show abstract

Section: Discussionsupporting

confidence: 61%

Offset layered closure reduces deep wound infection in early-onset scoliosis surgery

Grzywna

Miller

Glotzbecker

et al. 2016

Journal of Pediatric Orthopaedics B

View full text Add to dashboard Cite

show abstract

“…Whereas repair following an isolated dermal sinus tract resection may be relatively uncomplicated with primary dural and fascial closure, repairs fol-lowing large spinal cord lipomas may be more challenging. The importance of meticulous multilayer wound closure has been emphasized in the literature, with particular attention to decreasing the risk of CSF leak, but no scientific studies have explored strategies specifically designed to decrease wound infection rates following complex tethered cord repair [21][22][23][24][25][26]. This led to a recent Delphi study surveying 17 pediatric neurosurgeons and identifying 16 consensus-driven best practices to decrease wound complications.…”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Gram-Negative Rod and Multi-Organism Surgical Site Infections after Pediatric Complex Tethered Spinal Cord Surgery: Preliminary Report from a Single-Center Study

Alexiades¹,

Shao²,

Saiman³

et al. 2020

Pediatr Neurosurg

View full text Add to dashboard Cite

Background: Surgical site infections (SSIs) are one of the most common complications following pediatric complex tethered spinal cord release. This patient population is similar in some ways to the neuromuscular scoliosis population, in which higher-than-expected rates of gram-negative SSIs have been identified. Methods: We conducted a single-center retrospective chart review of all patients who underwent complex tethered spinal cord release over a 10-year period between 2007 and 2017. Results: A total of 69 patients were identified, with 10 documented SSIs (14%). 50% of the SSIs were polymicrobial or included at least 1 gram-negative organism. Among the organisms isolated, 3 were fully or partially resistant to cefazolin, the most common antibiotic prophylaxis in this population. Conclusion: Among children undergoing complex tethered spinal cord release, gramnegative and polymicrobial infections are a significant cause of SSIs. Although further multicenter data are needed, these findings suggest that standard antibiotic prophylaxis with cefazolin may not be sufficient.

show abstract

“…25,26 Closure of the paraxial muscles as a layer separate from the fascia had consensus on the initial survey likely based on several early studies in the complex tethered cord literature supporting multilayer soft-tissue closure as a means of decreasing CSF leak rates. 2,36 Following the initial Delphi round, consensus was also reached on the recommendation against the routine placement of postoperative drains (82.35% agree or strongly agree) with the group citing a lack of evidence for their benefit.…”

Section: Intraoperative Best Practice Statementsmentioning

confidence: 99%

Development of best practices to minimize wound complications after complex tethered spinal cord surgery: a modified Delphi study

Alexiades

Ahn

Blount

et al. 2018

Journal of Neurosurgery: Pediatrics

View full text Add to dashboard Cite

OBJECTIVEComplications after complex tethered spinal cord (cTSC) surgery include infections and cerebrospinal fluid (CSF) leaks. With little empirical evidence to guide management, there is variability in the interventions undertaken to limit complications. Expert-based best practices may improve the care of patients undergoing cTSC surgery. Here, authors conducted a study to identify consensus-driven best practices.METHODSThe Delphi method was employed to identify consensual best practices. A literature review regarding cTSC surgery together with a survey of current practices was distributed to 17 board-certified pediatric neurosurgeons. Thirty statements were then formulated and distributed to the group. Results of the second survey were discussed during an in-person meeting leading to further consensus, which was defined as ≥ 80% agreement on a 4-point Likert scale (strongly agree, agree, disagree, strongly disagree).RESULTSSeventeen consensus-driven best practices were identified, with all participants willing to incorporate them into their practice. There were four preoperative interventions: (1, 2) asymptomatic AND symptomatic patients should be referred to urology preoperatively, (3, 4) routine preoperative urine cultures are not necessary for asymptomatic AND symptomatic patients. There were nine intraoperative interventions: (5) patients should receive perioperative cefazolin or an equivalent alternative in the event of allergy, (6) chlorhexidine-based skin preparation is the preferred regimen, (7) saline irrigation should be used intermittently throughout the case, (8) antibiotic-containing irrigation should be used following dural closure, (9) a nonlocking running suture technique should be used for dural closure, (10) dural graft overlay should be used when unable to obtain primary dural closure, (11) an expansile dural graft should be incorporated in cases of lipomyelomeningocele in which primary dural closure does not permit free flow of CSF, (12) paraxial muscles should be closed as a layer separate from the fascia, (13) routine placement of postoperative drains is not necessary. There were three postoperative interventions: (14) postoperative antibiotics are an option and, if given, should be discontinued within 24 hours; (15) patients should remain flat for at least 24 hours postoperatively; (16) routine use of abdominal binders or other compressive devices postoperatively is not necessary. One intervention was prioritized for additional study: (17) further study of additional gram-negative perioperative coverage is needed.CONCLUSIONSA modified Delphi technique was used to develop consensus-driven best practices for decreasing wound complications after cTSC surgery. Further study is required to determine if implementation of these practices will lead to reduced complications. Discussion through the course of this study resulted in the initiation of a multicenter study of gram-negative surgical site infections in cTSC surgery.

show abstract

Paravertebral Turnover Flaps for Closure of Large Spinal Defects Following Tethered Cord Repair

Cited by 11 publications

References 21 publications

Offset layered closure reduces deep wound infection in early-onset scoliosis surgery

Offset layered closure reduces deep wound infection in early-onset scoliosis surgery

High Prevalence of Gram-Negative Rod and Multi-Organism Surgical Site Infections after Pediatric Complex Tethered Spinal Cord Surgery: Preliminary Report from a Single-Center Study

Development of best practices to minimize wound complications after complex tethered spinal cord surgery: a modified Delphi study

Contact Info

Product

Resources

About