Pedicled omental flaps as an adjunct in the closure of complex spinal wounds
Brian A O'Shaughnessy1, Gregory A Dumanian, John C Liu
1Department of Neurological Surgery and Division of Plastic Surgery, Feinberg School of Medicine, McGaw Medical Center, Northwestern University, Chicago, IL 60611, USA.
Study Design:
A retrospective clinical study.
Objective:
To evaluate the safety and efficacy of using an omental flap in complex spine reconstruction in patients at high-risk for wound dehiscence.
Summary Of Background Data:
Postoperative wound dehiscence represents a major cause of morbidity in patients undergoing instrumented spinal reconstruction. A variety of approaches for the prevention and treatment of this problem have been previously described in the literature; however, the use of omental flaps has received little attention.
Methods:
In this retrospective analysis, 5 patients were studied both clinically and radiographically. The study population included 4 women and 1 man, with a mean age of 49 years (range, 31-67 years). All patients underwent an omental flap procedure at the time of spinal reconstruction because of significant soft tissue defects or active spinal infection. Mean clinicoradiographic follow-up was 53 months (range, 36-115 months).
Results:
At the time of follow-up, all patients had well-healed surgical wounds with an acceptable structural and esthetic result. One patient in the study group experienced minor supra-fascial wound dehiscence. In terms of spinal outcome, all patients achieved successful bony arthrodesis; 1 patient, however, developed symptomatic adjacent segment degeneration and was treated by extension of the fusion construct.
Conclusion:
In patients undergoing thoracolumbar surgery who are at high risk of spinal wound dehiscence, closure using a pedicled omental flap is a viable procedure that may limit the risk of dehiscence and improve outcome.
