Ten Years After: A Decade of Experience Using Muscle Flap Closure Following Complex Spine Surgery to Lower Morbidity
Matthew A. Wright1, Jaime L. Bernstein2, Philipp Franck2, Arash Samadi1, Daniel O. Lara1, Leslie E. Cohen2, Jason A. Spector1.
1Laboratory of Bioregenerative Medicine and Surgery, Weill Cornell Medical College, New York, NY, USA, 2Department of Surgery, Weill Cornell Medical College, New York, NY, USA.
PURPOSE: Wound complications are a frequent occurrence after complex spine surgery, with an incidence as high as 40% in very high-risk patients and a reoperation rate approaching 12%. Moreover, the sequelae of a wound complication in such patients, including CSF leak, infection, or hardware exposure, can have devastating consequences. We have previously shown that muscle flap closure after complex spine surgery results in a significantly decreased need for reoperation due to wound complication in very high-risk cases. While it is becoming increasingly common for plastic surgeons to perform local muscle flap closure following the complex spinal procedures, there remain a relative paucity of data to support this practice. The purpose of the present study is to expand on these data and examine the surgical outcomes in the largest cohort of complex spine patients to date. METHODS: In this retrospective review, 344 consecutive cases (313 patients) of complex spine surgery with immediate muscle flap closure (paraspinous, trapezius, latissimus dorsi, and/or thoracolumbar fascia) by the senior author from 2006 through 2018 at Weill Cornell Medical College were identified. The electronic medical record for each case was reviewed, and patient characteristics, perioperative details, and outcomes were recorded. RESULTS: In total, 15 cases (4.4%) required reoperation due to wound complication. There were 22 cases (6.4%) of new postoperative infection, 11 of which (3.2%) required reoperation for successful resolution of the infection. There were 22 cases (6.4%) of wound dehiscence, two of which required reoperation for successful resolution. Finally, there were 47 cases (13.7%) of postoperative seroma, one of which required reoperation for excision of the seroma cavity. The one remaining wound complication requiring operative intervention was a postoperative hematoma. CONCLUSIONS: In this large series of 344 cases spanning over 12 years, we demonstrate that only 4.4% of complex spine cases with muscle flap closure required reoperation due to wound complication - an incidence much lower than that reported in the literature for complex spine cases closed without muscle flap advancement. These data show that muscle flap closure after complex spine surgery is an effective method for significantly reducing the need for reoperation due to wound complication and suggest that all cases of complex spine surgery may potentially benefit from such closure.
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