Monday, October 4, 2010
18404

Component Separation of the Back: A Simple Modification for the Closure of Complex Spinal Wounds

Justin M. Dazley, MD1, Marc A. Agulnick, MD2, Kristen A. Aliano, BA3, Steven Stavrides, RPA-C4, Matthew S. Kilgo, MD, FACS5, Tommaso Addona, MD5, Benjamin Cohen, MD2, Ryan M. Vellinga, BS3, and Thomas A. Davenport, MD4. (1) Department of Orthopaedics, Stony Brook University, HSC T-18 Room 089, Stony Brook, NY 11794, (2) 999 Franklin Avenue, Garden City, NY 11530, (3) Stony Brook University School of Medicine, HSC Level 4, Stony Brook, NY 11794, (4) Long Island Plastic Surgical Group, 999 Franklin Avenue, Garden City, NY 11530, (5) Plastic Surgery, Long Island Plastic Surgical Group, 999 Franklin Avenue, Garden City, NY 11530

Objective: We aimed to introduce a modified paraspinous muscle flap technique for the closure of complex spinal wounds and to compare it to current techniques of complex spinal wound coverage with regard to wound complications and hardware salvage.

Methods: We reviewed the medical records of patients who underwent complex or revision spinal procedures by a single fellowship trained spine surgeon from 2007-2009. All patients had primary wound closure by a consultant fellowship trained reconstructive plastic surgeon by the component separation paraspinous muscle (CSPM) flap technique. Post-operative courses were reviewed for complications including re-infection, including seroma/hematoma, requiring return to the operating room. Hardware salvage was used as an endpoint measuring successful wound closure. Length of hospital stay was also noted. Outcomes were compared with current techniques of complex spinal wound closure.

Results: Of those 53 patients meeting inclusion criteria, 30.2% underwent surgery for osteomyelitis, 22.6% for pseudarthrosis, 30.2% for degenerative/deformity conditions, 5.7% for tumor, and 9.4% for other diagnoses. Three patients (5.7%, 95% CI 1.2%-15.7%) were found to have re-infection/abscess requiring return to the operating room, which was significantly less than many published series' reports of approximately 20% infection rates (p<0.05). The average length of hospital stay for the subjects was 16.1 days (range 2-135) with patients staying 12.7 days post-operatively on average (range 2-110). A learning curve was observed, with 67% of all complications occurring in the first several months of the series (p<0.05). One hundred percent of patients had hardware salvaged at average follow up of seventeen months.

Conclusions: The CSPM flap closure compares favourably with techniques current in the literature, showing significantly lower rates of wound complications, as well as one hundred percent hardware salvage. The CSPM flap technique is a simple modification of local flap coverage of complex spinal wounds, offering superior results for their primary closure, and may help avoid costly and potentially dangerous returns to the operating room.

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