title: Optimizing Successful Outcomes in Complex Spine Reconstruction Using Local Muscle Flaps.
abstract: BACKGROUND
  Postoperative wound complications in patients undergoing complex spinal surgery can have devastating sequelae, including hardware exposure, meningitis, and unplanned reoperation. The literature shows that wound complication rates in this patient population approach 19 percent and, in very high-risk patients (i.e., prior spinal surgery, existing spinal wound infection, cerebrospinal fluid leak, malignancy, or history of radiation therapy), as high as 40 percent and with reoperation rates as high as 12 percent. The authors investigated whether prophylactic closure of spinal wounds with muscle flaps improves outcomes.
  
  
  METHODS
  A retrospective review was performed of 102 reconstructions (in 96 patients) in which spinal wound closure was performed by means of paraspinous, trapezius, or latissimus muscle advancement flaps by a single plastic surgeon (J.A.S.) from 2006 to 2014. Data regarding presurgical diagnosis, patient demographics, and incidence of postoperative complications were recorded.
  
  
  RESULTS
  One hundred two reconstructions were included, with follow-up ranging from 2 to 60 months. Eighty-eight reconstructions were classified as very high-risk for wound complications, defined as those having prior spinal surgery, existing spinal wound infection, cerebrospinal fluid leak, malignancy, or prior radiation therapy. Within the very high-risk group, there were six wound complications (6.8 percent), three of which (3.4 percent) required reoperation.
  
  
  CONCLUSIONS
  In this study, there is a markedly lower rate (6.8 percent) of postoperative wound complications compared with historical controls after closure of spinal wounds with local muscle flaps in very high-risk patients. These data encourage safe and routine use of muscle flaps for closure in this cohort of patients undergoing spinal surgery.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: New York, N.Y. From the Division of Plastic Surgery and the Department of Neurosurgery, Weill Cornell Medical College.
authors.forename: Leslie E
authors.initials: LE
authors.lastname: Cohen
authors.forename: Natalia
authors.initials: N
authors.lastname: Fullerton
authors.forename: Lily R
authors.initials: LR
authors.lastname: Mundy
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Weinstein
authors.forename: Kai-Ming
authors.initials: KM
authors.lastname: Fu
authors.forename: Jill J
authors.initials: JJ
authors.lastname: Ketner
authors.forename: Roger
authors.initials: R
authors.lastname: Härtl
authors.forename: Jason A
authors.initials: JA
authors.lastname: Spector
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013124:Spinal Injuries / Q000175:diagnosis / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply* / Q000637:transplantation; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology