Abstract
Obje ct A systematic review of the available evidence on the prophylactic and therapeutic use of flaps for the coverage of complex spinal soft-tissue defects was performed to determine if the use of flaps reduces postoperative complications and improves patient outcomes. Met hods A PubMed database search was performed to identify English-language articles published between 1990 and 2014 that contained the following phrases to describe postoperative wounds ("wound," "complex back wound," "postoperative wound," "spine surgery") and intervention ("flap closure," "flap coverage," "soft tissue reconstruction," "muscle flap"). Results In total, 532 articles were reviewed with 17 articles meeting the inclusion criteria of this study. The risk factors from the pooled analysis of 262 patients for the development of postoperative complex back wounds that necessitated muscle flap coverage included the involvement of instrumentation (77.6%), a previous history of radiotherapy (33.2%), smoking (20.6%), and diabetes mellitus (17.2%). In patients with instrumentation, prophylactic coverage of the wound with a well-vascularized flap was shown to result in a lower incidence of wound complications. One study showed a statistically significant decrease in complications compared with patients where prophylactic coverage was not performed (20% vs 45%). The indications for flap coverage after onset of wound complications included hardware exposure, wound infection, dehiscence, seroma, and hematoma. Flap coverage was shown to decrease the number of surgical debridements needed and also salvage hardware, with the rate of hardware removal after flap coverage ranging from 0% to 41.9% in 4 studies. Con clusion s Prophylactic coverage with flaps in high-risk patients undergoing spine surgery reduces complications, while therapeutic coverage following wound complications allows the salvage of hardware in the majority of patients.
| Original language | English (US) |
|---|---|
| Article number | E17 |
| Journal | Neurosurgical Focus |
| Volume | 39 |
| Issue number | 4 |
| DOIs | |
| State | Published - 2015 |
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Keywords
- Back flaps
- Complications of spinal surgery
- Spine
ASJC Scopus subject areas
- Surgery
- Clinical Neurology
Cite this
Reconstruction of open wounds as a complication of spinal surgery with flaps : A systematic review. / Chieng, Lee Onn; Hubbard, Zachary; Salgado, Christopher; Levi, Allan D; Chim, Harvey.
In: Neurosurgical Focus, Vol. 39, No. 4, E17, 2015.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Reconstruction of open wounds as a complication of spinal surgery with flaps
T2 - A systematic review
AU - Chieng, Lee Onn
AU - Hubbard, Zachary
AU - Salgado, Christopher
AU - Levi, Allan D
AU - Chim, Harvey
PY - 2015
Y1 - 2015
N2 - Obje ct A systematic review of the available evidence on the prophylactic and therapeutic use of flaps for the coverage of complex spinal soft-tissue defects was performed to determine if the use of flaps reduces postoperative complications and improves patient outcomes. Met hods A PubMed database search was performed to identify English-language articles published between 1990 and 2014 that contained the following phrases to describe postoperative wounds ("wound," "complex back wound," "postoperative wound," "spine surgery") and intervention ("flap closure," "flap coverage," "soft tissue reconstruction," "muscle flap"). Results In total, 532 articles were reviewed with 17 articles meeting the inclusion criteria of this study. The risk factors from the pooled analysis of 262 patients for the development of postoperative complex back wounds that necessitated muscle flap coverage included the involvement of instrumentation (77.6%), a previous history of radiotherapy (33.2%), smoking (20.6%), and diabetes mellitus (17.2%). In patients with instrumentation, prophylactic coverage of the wound with a well-vascularized flap was shown to result in a lower incidence of wound complications. One study showed a statistically significant decrease in complications compared with patients where prophylactic coverage was not performed (20% vs 45%). The indications for flap coverage after onset of wound complications included hardware exposure, wound infection, dehiscence, seroma, and hematoma. Flap coverage was shown to decrease the number of surgical debridements needed and also salvage hardware, with the rate of hardware removal after flap coverage ranging from 0% to 41.9% in 4 studies. Con clusion s Prophylactic coverage with flaps in high-risk patients undergoing spine surgery reduces complications, while therapeutic coverage following wound complications allows the salvage of hardware in the majority of patients.
AB - Obje ct A systematic review of the available evidence on the prophylactic and therapeutic use of flaps for the coverage of complex spinal soft-tissue defects was performed to determine if the use of flaps reduces postoperative complications and improves patient outcomes. Met hods A PubMed database search was performed to identify English-language articles published between 1990 and 2014 that contained the following phrases to describe postoperative wounds ("wound," "complex back wound," "postoperative wound," "spine surgery") and intervention ("flap closure," "flap coverage," "soft tissue reconstruction," "muscle flap"). Results In total, 532 articles were reviewed with 17 articles meeting the inclusion criteria of this study. The risk factors from the pooled analysis of 262 patients for the development of postoperative complex back wounds that necessitated muscle flap coverage included the involvement of instrumentation (77.6%), a previous history of radiotherapy (33.2%), smoking (20.6%), and diabetes mellitus (17.2%). In patients with instrumentation, prophylactic coverage of the wound with a well-vascularized flap was shown to result in a lower incidence of wound complications. One study showed a statistically significant decrease in complications compared with patients where prophylactic coverage was not performed (20% vs 45%). The indications for flap coverage after onset of wound complications included hardware exposure, wound infection, dehiscence, seroma, and hematoma. Flap coverage was shown to decrease the number of surgical debridements needed and also salvage hardware, with the rate of hardware removal after flap coverage ranging from 0% to 41.9% in 4 studies. Con clusion s Prophylactic coverage with flaps in high-risk patients undergoing spine surgery reduces complications, while therapeutic coverage following wound complications allows the salvage of hardware in the majority of patients.
KW - Back flaps
KW - Complications of spinal surgery
KW - Spine
UR - http://www.scopus.com/inward/record.url?scp=84947439054&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84947439054&partnerID=8YFLogxK
U2 - 10.3171/2015.7.FOCUS15245
DO - 10.3171/2015.7.FOCUS15245
M3 - Article
C2 - 26424341
AN - SCOPUS:84947439054
VL - 39
JO - Neurosurgical Focus
JF - Neurosurgical Focus
SN - 1092-0684
IS - 4
M1 - E17
ER -