<< Back to the abstract archive
Flap Closure of Spinal Defects in High-Risk Patients: A Ten-Year Institutional Experience
Elizabeth M. Kenny, MD
Isaac B. James, MD
Fuat Barış Bengür, MD
Ernest K. Manders, MD
James M. Russavage, MD, DMD
Tahsin Oğuz Acartürk, MD
University of Pittsburgh Medical Center
2021-02-15
Presenter: Elizabeth M. Kenny, MD
Affidavit:
Vu T. Nguyen
Director Name: Vu T. Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Complication rates following spinal surgery are high, in part due to surgical advancements that have made procedures available to a broader range of medically complicated patients. The high rates of infection, hematoma, and dehiscence resulting in open wounds after spinal surgery often warrants plastic surgery involvement. In this study, we aim to examine the effects of preoperative and operative risk factors on complication rates, reoperation rates, and hospital length of stay after flap reconstruction of spinal defects.
Methods: A retrospective review was performed of 373 patients who required flap reconstruction for spinal wound closure at our institution between 2003 and 2013. Data regarding demographics, comorbidities, operative variables, and post-reconstructive course were collected.
Results: Of 373 patients, 97.3% had at least one comorbid condition associated with poor wound healing, 91.2% had a significant wound condition at the time of reconstruction, and 81.8% had a history of ≥2 spinal surgeries. Following reconstruction, average hospital stay was 14 days, with 35% of patients developing complications and 30% requiring reoperation. Risk factors including elevated BMI, diabetes, tobacco use, steroid use, low prealbumin, therapeutic anticoagulation, infection, history of spine surgery, multilevel spinal reconstruction, and spinal hardware were associated with complications, reoperations, and prolonged length of stay (p<0.05).
Conclusions: Local muscle flap coverage is an effective strategy for the reconstruction of spinal defects in medically complex patients. To reduce the inherently high risks associated with paraspinous reconstruction in this challenging population, special consideration should be given to preoperative and operative variables associated with poor outcomes.
