Myofascial Flap Closure Decreases Complications in Complex Surgery of the Craniocervical Junction in Ehlers-Danlos Patients
Sofya Norman, BS1, John K. Chae, BA1, Andrew A. Marano, MD1, Ali A. Baaj, MD2, Jeffrey P. Greenfield, MD, PhD1, David M. Otterburn, MD1
1New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, 2University of Arizona, Banner Health, Phoenix, AZ
Introduction: Patients with Ehlers-Danlos Syndrome (EDS) are at elevated risk for soft tissue complications when undergoing decompression with or without fusion of the craniocervical junction. We have previously shown that muscle flap closure can decrease reoperative rates. This study investigates whether myofascial flap closure improves clinical outcomes following simple or complex surgery of the craniocervical junction in EDS patients specifically.
Methods: We performed a retrospective chart review of EDS patients who had undergone surgery for Chiari malformation at Weill Cornell Medical Center between 2013 and 2020. Postoperative complications were recorded and patients were stratified by type of closure and type of surgery. Fisher’s Exact Test was used for statistical comparison.
Results: Between 2013 and 2020, 62 EDS patients who had surgery of the cervicocranial junction were reviewed. Of these, 31 patients had complex surgery with myofascial flap closure and 22 had simple surgery with traditional closure. There were no significant differences in wound complications or reoperation rates between the simple surgery and complex surgery groups. Also, there were no significant differences in complications between complex surgery with flap closure and simple surgery with traditional closure. Our CSF cutaneous fistula rate was 0%, considerably lower than rates reported in the literature.
Conclusion: Flap closure reduced complications following complex surgery of the craniocervical junction to the level of simple surgery. Further, our CSF leak rate was exceptionally low. Therefore, patients with EDS undergoing surgery of the cervicocranial junction may benefit from myofascial flap closure.
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