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Paraspinous Muscle Flaps for Closure of Midline Post-Spinal Surgery Defects
Ivan Vial, Lauren Zammerilla, Zhang Xiaoran, Udayan Srivastava, Vincent Chavanon, Bonnie Lu, James Russavage, Ernest Manders, Oguz T. Acarturk
UPMC
2013-03-14
Presenter: Ivan Vial
Affidavit:
100%
Director Name: Joe Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction: Complications arising from spinal trauma and spinal surgery can result in exposed bone, exposed hardware, dead space, cerebrospinal fluid leak, and infection. Mid-spinal area is a difficult area to reconstruct. One underutilized flap is the paraspinous muscle flap. We present our experience with 150 paraspinous flaps that were used to reconstruct difficult or recalcitrant spinal midline defects.
Methods: A retrospective review of 150 patients who underwent bilateral paraspinous muscle flaps for the reconstruction of midline back defects was performed. The indication of use of paraspinous muscle were postoperative infection, exposed hardware, wide defect area and depth following spinal fixation, persistent CSF leak, wound dehiscence and/or non-healing wound.
Results: Rates of post-operative flap complications defined as infection, cerebrospinal fluid leak, dehiscence, or need for reoperation were reviewed. Preoperative risk factors including low pre-albumin, hypertension, diabetes, obesity, smoking, chronic steroid use, and previous spinal surgeries were analyzed and odds ratios for flap failure calculated based on premorbid conditions. There were no flap necroses in the series. There was 90% complete success rate without any complications. 5% of patients had minor complications with an eventual good outcome. 5% of patients had major complications which required reoperation. Eventually, 98% of all patients had good outcomes.
Conclusion: Patients undergoing paraspinous muscle flap for back reconstruction showed durable long terms wound stability increasing the safety of spinal surgery in complex and recalcitrant cases.
