The management of complex soft-tissue defects after spinal instrumentation

Singh, Kern; Samartzis, Dino; Heller, John G.; An, Howard S.; Vaccaro, Alexander R.

doi:10.1302/0301-620x.88b1.16837

Cited by 25 publications

(25 citation statements)

References 84 publications

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“…33 Of these 6 patients, 4 (67%) developed wound complications. Three patients underwent colostomy for bowel diversion prior to or at the time of the procedure.…”

Section: Perioperative Risk Factorsmentioning

confidence: 99%

“…Simple midline closures without proper obliteration of resultant dead space have been associated with complications such as hematoma, seroma, infection, fistula formation, and bowel obstruction; in contrast, recruitment of local or distal vascularized flaps can fill the dead space and prevent postoperative infection or dehiscence. 15,28,29,33,35 Sacroperineal herniation is a rare but significant complication that results from increased intraabdominal pressure or denervation atrophy of the pelvic diaphragm. If the perineal muscles cannot be satisfactorily approximated, a prosthetic rectal sling may be fashioned in conjunction with a local flap to create a tension-free barrier again posterior herniation of pelvic contents.…”

Section: Soft-tissue Reconstructionmentioning

confidence: 99%

“…For cases in which the GM flap is found to have insufficient bulk-especially in elderly patients with attenuated tissue-regional flaps of the posterior thigh, PSM, or pedicled LD may be mobilized to obliterate the dead space. 26,33 A "reverse turnover" LD muscle flap covered with splitthickness skin grafts has been successfully used as a principal flap for lumbosacral defects. 9,22,37 The LD muscle is detached at its insertion at the humerus, separating it from the thoracodorsal artery, vein, and nerve.…”

Section: Gluteal Flapmentioning

confidence: 99%

“…The belly of the muscle is then reversed and inset into the wound, with vascular supply based on the secondary segmental parasinous vessels. 33 It is our recommendation that the reverse turnover LD flap be considered when gluteal vessels are not intact or local muscles are insufficient for coverage of the defect (Fig. 1).…”

Section: Gluteal Flapmentioning

confidence: 99%

“…25,28 The main disadvantage is the need for an anterior approach for flap harvest, which may require an additional stage or intraoperative positioning change. 33 The use of the omental flap is contraindicated in the case of prior radiation or resection of abdominal tissue, or morbid obesity. Previously described complications include wound dehiscence, seroma, deep wound infection, chylous leak, ileus, ventral herniation, and presacral abscess.…”

Section: Omental Flapmentioning

confidence: 99%

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Soft-tissue reconstruction after total en bloc sacrectomy

Kim

Pang²,

Christensen³

et al. 2015

SPI

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OBJECT Total en bloc sacrectomy is a dramatic procedure that results in extensive sacral defects. The authors present a series of patients who underwent flap reconstruction after total sacrectomy, report clinical outcomes, and provide a treatment algorithm to guide surgical care of this unique patient population. METHODS After institutional review board approval, data were collected for all patients who underwent total sacrectomy between 2002 and 2012 at The Johns Hopkins Hospital. Variables included demographic data, medical history, tumor characteristics, surgical details, postoperative complications, and clinical outcomes. All subtotal sacrectomies were excluded. RESULTS Between 2002 and 2012, 9 patients underwent total sacrectomy with flap reconstruction. Diagnoses included chordoma (n = 5), osteoblastoma (n = 1), sarcoma (n = 2), and metastatic colon cancer (n = 1). Six patients received gluteus maximus (GM) flaps with a prosthetic rectal sling following a single-stage, posterior sacrectomy. Four required additional paraspinous muscle (PSM) or pedicled latissimus dorsi (LD) fasciocutaneous flaps. Three patients underwent multistage sacrectomy with an anterior-posterior approach, 2 of whom received pedicled vertical rectus abdominis myocutaneous (VRAM) flaps, and 1 of whom received local GM, LD, and PSM flaps. Flap complications included dehiscence (n = 4) and infection (n = 1). During the 1st year of follow-up, 2 of 9 patients (22%) were able to ambulate with an assistive device by the 1st postoperative month, and 6 of 9 (67%) were ambulatory with a walker by the 3rd postoperative month. By postoperative Month 12, 5 of 9 patients (56%)—or 5 of 5 patients not lost to follow-up (100%)—were able to able to ambulate independently. CONCLUSIONS The authors' experience suggests that the GM and pedicled VRAM flaps are reliable options for softtissue reconstruction of total sacrectomy defects. For posterior-only operations, GM flaps with or without a prosthetic rectal sling are generally used. For multistage operations including a laparotomy, the authors consider the pedicled VRAM flap to be the gold standard for simultaneous reconstruction of the pelvic diaphragm and obliteration of dead space.

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“…33 Of these 6 patients, 4 (67%) developed wound complications. Three patients underwent colostomy for bowel diversion prior to or at the time of the procedure.…”

Section: Perioperative Risk Factorsmentioning

confidence: 99%

Section: Soft-tissue Reconstructionmentioning

confidence: 99%

Section: Gluteal Flapmentioning

confidence: 99%

Section: Gluteal Flapmentioning

confidence: 99%

Section: Omental Flapmentioning

confidence: 99%

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Soft-tissue reconstruction after total en bloc sacrectomy

Kim

Pang²,

Christensen³

et al. 2015

SPI

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Versatility of perforator‐based V‐Y advancement flaps in reconstruction of complex mid back wounds

et al. 2011

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Reconstruction of complex mid back wounds is challenging due to the patient comorbidities and scarcity of reliable regional flap alternatives. Four consecutive cases treated with perforator based V-Y advancement flaps are reported. An effective repair was achieved in all the patients and the mean follow up period was 28 months. Our results indicate the efficacy of adipocutaneous flaps in complex spinal soft tissue repair and may help to refine the relevant algorhythm.

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