A 10-Year Retrospective Review on the Use of Prophylactic and Salvage Paraspinous Flaps in Spinal Surgery
Michael Ha1, Ledibabari M. Ngaage1,2, Seray Er1, Salman Choudhry3, Richard Smith4, Madeline Brown1, Allison S. Karwoski, BS1, Yvonne M. Rasko1
1 - Division of Plastic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD2 - Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD3 - Department of Surgery, Anne Arundel Medical Center, Annapolis, MD4 - Department of Microbial Pathogenesis, School of Dentistry, University of Maryland Baltimore, Baltimore, MD
Introduction: Complex spinal surgery can harbor devastating postoperative wound complications, such as hardware exposure, reoperation and potential hardware loss. Paraspinous muscular flaps have been suggested to aid in the wound closure and healing in these patients. Literature has previously shown that complication rates have ranged from 19-40 percent, with a reoperation rate of up to 12 percent. The authors investigated whether prophylactic closure of the spinal wounds with muscle flap improves outcomes, as compared to salvage operations.
Methods: An institutional review board (IRB)-approved retrospective review of patients who underwent a multi-level spinal surgery with concurrent muscle flap coverage at a single institution (August 2011 to November 2021) was done. Patient demographics, clinical profile, procedures, and outcomes at a minimum 90-days post-operatively have been described.
Results: 73 prophylactic flaps in 60 patients were compared with 47 salvage flaps in 38 patients. Between the two cohorts, there was no significant difference between the mean age (60.6 vs 59.3), BMI (26.7 vs 29.4) or length of post op stay (8.8 vs 8.6). Salvage flaps however were more likely to have a larger initial wound defect size 103.5cm2 bs 93cm2, p=0.045) and a longer length of operation (285 minutes vs 133 mins, p<0.001). Though there was no notable difference in complication rates, prophylactic flaps were less likely to lead to a re-operation (7% vs 11%, p = 0.034).
Conclusion: Paraspinous flaps have been described as a useful adjunct to complex spinal surgery to aid in would healing. This article supports their safe and routine utility for closures in this cohort of patients, as either a prophylactic or salvage-based means.
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