Immediate debridement and coverage of exposed spinal hardware with muscle flaps

We report the outcome of immediate débridement and soft tissue cover of spinal wounds secondary to exposure of orthopedic hardware, using local muscle or musculocutaneous flaps. Five patients were treated (mean age 18 years). Radical débridement was performed prior to flap closure. Depending on the location of the defect, a pedicled muscle or myocutaneous flap was selected, alone or in combination with latissimus dorsi, trapezius, gluteus maximus, or paraspinous muscles. The implants were successfully covered. The hardware was maintained until solid spinal fusion was achieved. We recommend early and definitive cover of exposed spinal fusion devices using local muscle or musculocutaneous flaps; the choice depends on the location of the defect. By this approach the wound can be effectively repaired with a well-vascularized muscle flap covering the hardware, thus obviating the need for its removal and thus ensuring spinal stability.