Muscle flap salvage of spine wounds with soft tissue defects or infection

Study Design. This retrospective study was designed to analyze the results of 22 patients treated for postoperative soft tissue defects of the spine. Objective. To demonstrate the utility of flaps in the salvage of spine wounds. Summary of Background Data. In the literature, the treatment of postoperative spine infections is with serial debridement, antibiotic irrigation catheters, drains, and occasional removal of spinal implants. Muscle flaps have received scant mention in the surgical literature for spine coverage. Methods. Group 1 (n = 15) had postoperative wound infections or dehiscences. Group 2 (n = 7) had "prophylactic" flaps at the time of their initial spine surgery. The indications for "prophylactic" closure included multiple prior surgeries, prior infection, and previous radiation therapy. Group 1 was treated with drainage, dressing changes, and one-stage flap closure of their wounds. Sliding paraspinal muscle flaps were the flaps of choice. Group 2 was treated with a variety of closure techniques at the time of their initial surgery. Results. The average defect size was 10 vertebral bodies long. Despite the large defect size, 19 of 20 surviving patients currently have healed wounds, and all the patients have maintained their instrumentation. Two patients died of causes unrelated to their wound problems. A Group 1 patient with complete loss of a superior gluteal artery flap was salvaged with a contralateral gluteus muscle flap. Another Group 1 patient has intermittent drainage from under a trapezius flap, which covers a cervical spine fusion. Four patients had minor wound complications. Conclusions. Flaps are a useful adjunct in the treatment of patients with complex spine wounds. Sliding paraspinal muscle flaps can effectively close wounds from the high cervical to the low lumbar area in one operative procedure. These patients can go on to successful spine fusion.