Immediate soft-tissue reconstruction for complex defects of the spine following surgery for spinal neoplasms

Background: Innovations in surgical approaches and instrumentation for spinal stabilization have allowed radical resections of advanced spinal neoplasms. Wounds that expose instrumentation and vital neural structures can have devastating consequences. In this study, the authors present a paradigm shift in the way complex wounds of the spine are managed, where immediate, prophylactic muscle-flap reconstruction is provided, particularly for those patients identified to be at high risk for wound-healing complications. The purpose of this study was to determine the outcomes of this new prophylactic approach to managing complex spine wounds. Methods: The authors retrospectively reviewed spine tumor patients who underwent immediate reconstruction for complex wounds of the spine from 2004 to 2008. From the prospectively maintained database and medical records, the authors collected information regarding reconstructive methods, defect location, patient conditions, complications, and revision operations. Results: Of the 52 patients, 34 (65 percent) had undergone prior irradiation, 17 (33 percent) had undergone prior surgery to the spine, and 44 (85 percent) had undergone spine instrumentation. Overall, six patients (12 percent) had major complications that required surgical intervention. The instrumentation did not need to be removed in any of the patients. All patients had a closed wound at their last clinic visit. Conclusions: Complex wounds of the spine benefit from immediate prophylactic reconstruction with muscle flaps. This approach has a high rate of success in achieving a stable, closed wound while minimizing major wound complications, even in the presence of adverse conditions such as prior irradiation, prior operations, and the presence of hardware.