title: Muscle flap salvage of spine wounds with soft tissue defects or infection.
abstract: METHODS
  This retrospective study was designed to analyze the results of 22 patients treated for postoperative soft tissue defects of the spine.
  
  
  OBJECTIVE
  To demonstrate the utility of flaps in the salvage of spine wounds.
  
  
  BACKGROUND
  In the literature, the treatment of postoperative spine infections is with serial débridement, antibiotic irrigation catheters, drains, and occasional removal of spinal implants. Muscle flaps have received scant mention in the surgical literature for spine coverage.
  
  
  METHODS
  Group 1 (n = 15) had postoperative wound infections or dehiscences. Group 2 (n = 7) had "prophylactic" flaps at the time of their initial spine surgery. The indications for "prophylactic" closure included multiple prior surgeries, prior infection, and previous radiation therapy. Group 1 was treated with drainage, dressing changes, and one-stage flap closure of their wounds. Sliding paraspinal muscle flaps were the flaps of choice. Group 2 was treated with a variety of closure techniques at the time of their initial surgery.
  
  
  RESULTS
  The average defect size was 10 vertebral bodies long. Despite the large defect size, 19 of 20 surviving patients currently have healed wounds, and all the patients have maintained their instrumentation. Two patients died of causes unrelated to their wound problems. A Group 1 patient with complete loss of a superior gluteal artery flap was salvaged with a contralateral gluteus muscle flap. Another Group 1 patient has intermittent drainage from under a trapezius flap, which covers a cervical spine fusion. Four patients had minor wound complications.
  
  
  CONCLUSIONS
  Flaps are a useful adjunct in the treatment of patients with complex spine wounds. Sliding paraspinal muscle flaps can effectively close wounds from the high cervical to the low lumbar area in one operative procedure. These patients can go on to successful spine fusion.
authors.affiliation: Division of Plastic Surgery, Department of Neurosurgery, Northwestern Memorial Hospital, Chicago, Illinois, USA. gdumania@nmh.org
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Dumanian
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Ondra
authors.forename: John
authors.initials: J
authors.lastname: Liu
authors.forename: Michael F
authors.initials: MF
authors.lastname: Schafer
authors.forename: Jerome D
authors.initials: JD
authors.lastname: Chao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000150:complications / Q000601:surgery*; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome; D014946:Wound Infection / Q000188:drug therapy / Q000601:surgery*