Article Abstract

Prophylactic muscle flap reconstruction after complex spine surgery for degenerative disease: case series and institutional protocol

Authors: Nikhil Adapa, Nikhil Jain, Allison Capek, Rajiv Chandawarkar, Safdar N. Khan, Yazeed M. Gussous, Elizabeth Yu


Background: Wound complications can occur in up to 20% of patients following multilevel posterior spinal fusion. Currently, the use of local flaps has been reported in high-risk patients with a history of spinal neoplasm, radiation therapy, exposed hardware, multiple spine surgeries, or wound infections. However, there are no reports of prophylactic muscle flap wound closure in patients undergoing multi-level spinal fusion for degenerative pathology. Given the extensive soft tissue dissection for exposure compounded by patient comorbidities, there is potential to minimize the risk of wound complications with prophylactic trapezius and/or paraspinal flap coverage. We sought to describe the utility and outcomes of prophylactic muscle flaps for wound coverage after instrumented posterior spinal fusion for multi-level degenerative spine disease and spinal deformity.
Methods: An institutional review board (IRB)-approved retrospective review of 26 consecutive patients who underwent a multi-level posterior spinal fusion for degenerative pathology with concurrent muscle flap coverage at a single institution (August 2016 to February 2017) was done. Patient demographics, clinical profile, procedures, and outcomes at a minimum 6-month post-operatively have been described.
Results: Patients had a mean age of 59.7±13.0 years with a mean body mass index (BMI) of 31.0±8.6 kg/m2. Paraspinous muscle flap (61.5%), trapezius (3.8%), and combination flaps (34.6%) were used for coverage of an average wound defect of 325 cm2 extending over average 10.2 vertebral levels. All wounds healed completely with no complications at an average of 9.1 months follow-up. Only one patient (3.8%) developed a seroma for which interventional radiology (IR)-drainage was sufficient.
Conclusions: Prophylactic trapezius and/or paraspinous muscle flap coverage using a team approach can reduce the risk of wound complications after extensive spinal fusion for multi-level degenerative disease or adult spinal deformity (ASD). Preliminary results from our institution suggest that routine use of such a protocol has the potential to improve quality of care and reduce healthcare expenditure associated with this relatively morbid procedure.