Reconstruction of Lumbar Spinal Defects: Case Series, Literature Review, and Treatment Algorithm

Daly, Lauren; Ortíz, Ricardo; Shin, John H.; Bojovic, Branko; Eberlin, Kyle R.

doi:10.1097/gox.0000000000002089

Cited by 8 publications

(3 citation statements)

References 62 publications

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“…Contemporaneous techniques involve mobilizing muscle and/or fascia, followed by skin closure. [3][4][5]20 Layered closure of deeper tissues serves to reinforce the dural repair, thereby decreasing the risk of cerebrospinal fluid leak. Tension-free closure of the skin-either by careful undermining or by creation of patterned flaps-decreases the risk of wound breakdown but results in significant subcutaneous dead space, which may serve as a reservoir for accumulation of blood, serum, or cerebrospinal fluid.…”

Section: Ementioning

confidence: 99%

Progressive-Tension Sutures in Reconstruction of Posterior Trunk Defects in Pediatric Patients: A Prospective Series

Crowe¹,

Hauptman²,

Lee³

et al. 2022

Plastic &Amp; Reconstructive Surgery

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oft-tissue reconstruction of the posterior trunk is frequently required in pediatric patients with spinal dysraphism disorders. [1][2][3][4][5] Following decompression and repair of the cord elements, sizable defects of the midline thoracic and lumbar regions can be reliably closed using adjacent skin, muscle, and muscle fascia. The primary goal of reconstruction is to provide robust, vascularized coverage of the dura and a tensionfree skin closure.Given the degree of dead space created secondary to the neurosurgical repair of the cord, debridement of devitalized or scarred tissue, and undermining of adjacent tissues, drains are often placed to prevent accumulation of fluid and provide negative pressure to collapse tissues. Classically regarded as standard of care, 6 the need for closed suction drains in several spinal procedures has been the subject of contemporaneous

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Section: Ementioning

confidence: 99%

Progressive-Tension Sutures in Reconstruction of Posterior Trunk Defects in Pediatric Patients: A Prospective Series

Crowe¹,

Hauptman²,

Lee³

et al. 2022

Plastic &Amp; Reconstructive Surgery

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…The reconstruction of the lumbosacral wound includes local rotation and advancement flaps, gluteal maximus flap, gluteal artery perforator flap, free flaps, and lumbar artery perforator flaps (Daly et al, 2019). The gluteus maximus flap is a safe option for pressure ulcer coverage but requires a muscle sacrifice.…”

Section: Discussionmentioning

confidence: 99%

Near‐total gluteal defect reconstruction with bilateral delayed giant lumbar artery perforator flaps: A case report

et al. 2023

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The reconstruction of the near‐total or total gluteal defects is challenging. Reconstructive options were restricted when the gluteal flaps were sacrificed. The lumbar artery perforator flap (LAPF) has been recently popularized as an alternative option for sacral and gluteal pressure ulcers. Extension of flap size may be needed in extensive defects. We aim to use the delay phenomenon to increase lumbar artery perforator flap territory to reconstruct near total gluteal defect. A 36‐year‐old woman was referred to our clinic with defect sizes of 23 × 23 cm and 25 × 17 cm for the right and left gluteal regions. She had a history of multiple surgeries for her paraplegia‐related sacrogluteal pressure sores. The reconstruction was started on the left side with delaying incisions to the flap borders. Seven days later, the left gluteal defect was reconstructed with 27 × 19 cm LAPF based on a second lumbar artery perforator. At the same session, the delaying incision was performed to the borders of the right LAPF. On day 14, the right gluteal defect was closed with a 25 × 25 cm‐sized right LAPF. No flap loss and early complications were seen. The patient was discharged without complication after 10 days after the last operation. The patient was followed up for 1 year. A right ischial pressure ulcer due to wheelchair use was encountered, which was managed with conservative wound care in the 8th month. Giant‐sized lumbar artery perforator flaps may be obtained by delay phenomenon to reconstruct near‐total or total gluteal pressure sores.

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Soft tissue coverage of a total gluteal defect with a combination of perforator‐based flaps: A case report

et al. 2020

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Soft tissue defects in the buttock area are often related to decubitus ulcers, which are usually small to medium-large size and can be regularly treated with local flaps. However, when the defects have bigger size, such as those involving the whole gluteal region, the coverage can become more challenging, since this specific area needs both a good resistance to pressure and an acceptable functional result. The most common solution for similar cases is the use of multiple local flaps, or, in extreme situations, a free flap. In particular, local flaps based on perforator vessels are, in selected cases, a consolidated alternative to free flap allowing an efficient reconstruction of soft tissue defects using adjacent similar tissues, providing the benefit of "like with like" coverage. Here we present a case of a large mycosis fungoides nidus of the gluteal region measuring 25 cm × 18 cm reconstructed using two large perforator flaps adjacent to the defect combined with a remote one for coverage of the donor site. The cranial flap was designed based on a perforator arising from the superior gluteal artery and transferred into the defect by means of a V-Y advancement, while the two caudal propeller flaps in the posterior thigh were both based on perforators of the profunda femoris artery and rotated 180 , respectively. To obtain a tension-free cover of the donor site defect we applied the concept of "sequential" propeller flaps. Post-operative course was uneventful and the patient was ambulatory with assistive devices after 1 week. At 6 months follow-up, wounds were completely healed without complications and a good functional result was obtained. This report showed the great coverage potential of multiple perforator-based local flaps when properly combined allowing primary closure of the donor site. In particular, we managed to reconstruct a total gluteal defect using just ipsilateral side tissue, reducing morbidity, and obtaining a stable result.

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Reconstruction of Lumbar Spinal Defects: Case Series, Literature Review, and Treatment Algorithm

Cited by 8 publications

References 62 publications

Progressive-Tension Sutures in Reconstruction of Posterior Trunk Defects in Pediatric Patients: A Prospective Series

Progressive-Tension Sutures in Reconstruction of Posterior Trunk Defects in Pediatric Patients: A Prospective Series

Near‐total gluteal defect reconstruction with bilateral delayed giant lumbar artery perforator flaps: A case report

Soft tissue coverage of a total gluteal defect with a combination of perforator‐based flaps: A case report

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