Spinal Wound Closure

Sukkarieh, Hamdi G.; Lawrence, Walter; Hitchon, Patrick W.

doi:10.1016/b978-0-323-40030-5.00165-9

Cited by 1 publication

(4 citation statements)

References 49 publications

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“…26 During mobilization, the skin and adjacent muscles such as the trapezius for the upper back or latissimus dorsi for the lower back are elevated, with careful preservation of the superficial paraspinous fascia. 27 An incision is made in the fascia near the medial perforating vessels, facilitating medial muscle advancement and allowing for midline muscle approximation. 25 Greater mobility can then be attained by dissecting beneath the muscles and severing the medial perforators.…”

Section: Discussionmentioning

confidence: 99%

“…25 Greater mobility can then be attained by dissecting beneath the muscles and severing the medial perforators. 27 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.…”

Section: Discussionmentioning

confidence: 99%

“…Generally mobilized bilaterally, these flaps are supplied segmentally by medial and lateral perforators 26 . During mobilization, the skin and adjacent muscles such as the trapezius for the upper back or latissimus dorsi for the lower back are elevated, with careful preservation of the superficial paraspinous fascia 27 . An incision is made in the fascia near the medial perforating vessels, facilitating medial muscle advancement and allowing for midline muscle approximation 25 .…”

Section: Discussionmentioning

confidence: 99%

“…An incision is made in the fascia near the medial perforating vessels, facilitating medial muscle advancement and allowing for midline muscle approximation 25 . Greater mobility can then be attained by dissecting beneath the muscles and severing the medial perforators 27 …”

Section: Discussionmentioning

confidence: 99%

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Paraspinous Muscle Flaps in Complex Pediatric Spine Surgeries

Falade,

Park,

Conkling

et al. 2024

Ann Plast Surg

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Purpose The benefits of paraspinous flaps in adult complex spine surgery patients are established in the literature; however, their use in pediatric patients has not been well described. This study compares clinical outcomes with and without paraspinous muscle flap closure in pediatric patients who have undergone spine surgery. Methods We conducted a retrospective review of all pediatric spine surgeries at the University of California, San Francisco from 2011 to 2022. Patients were divided into 2 cohorts based on whether the plastic surgery service closed or did not close the wound with paraspinous muscle flaps. We matched patients by age, American Society of Anesthesiology classification, prior spinal surgical history, and diagnosis. Surgical outcomes were compared between the 2 cohorts. Results We identified 226 pediatric patients who underwent at least one spinal surgery, 14 of whom received paraspinous flap closure by plastic surgery. They were matched in a 1:4 ratio with controls (n = 56) that did not have plastic surgery closure. The most common indication for plastic surgery involvement was perceived complexity of disease by the spine surgeon with concern for inadequate healthy tissue coverage (78.6%), followed by infection (21.4%). Postoperative complications were similar between the two groups. The plastic surgery cohort had a higher rate of patients who were underweight (57.1% vs 14.3%, P < 0.01) and had positive preoperative wound cultures (28.6% vs 8.9%, P = 0.05), as well as a higher rate of postoperative antibiotic usage (78.6 vs 17.9%, P < 0.01). There was no difference in recorded postoperative outcomes. Conclusions Spine surgeons requested paraspinous flap closure for patients with more complex disease, preoperative infections, history of chemotherapy, or if they were underweight. Patients with paraspinous flap coverage did not have increased postoperative complications despite their elevated risk profile. Our findings suggest that paraspinous muscle flaps should be considered in high-risk pediatric patients who undergo spine surgery.

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Section: Discussionmentioning

confidence: 99%