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Soft-tissue defects after spinal instrumentation in 5 children: risk factors, management strategies, and outcomes
Christina Sayama1, Sudhakar Vadivelu, Andrew Livingston
1Neuro-Spine Program, Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine;
Insights
Local tissue flaps effectively treat spinal instrumentation complications in pediatric patients, avoiding hardware removal and subsequent instability. This approach promotes healing and clears infection, preserving spinal support.
Area of Science:
- Pediatric Neurosurgery
- Orthopedic Surgery
- Wound Management
Background:
- Wound complications following pediatric spinal surgery can risk instrumentation.
- Soft-tissue defects from spinal implants require effective management.
Observation:
- This study reviewed 5 high-risk pediatric cases with spinal instrumentation erosion.
- Risk factors included young age, poor nutrition, prior surgeries, and radiation therapy.
Findings:
- The paraspinous flap was the primary treatment in 4 cases.
- Spinal instrumentation removal was necessary in 3 cases, leading to delayed instability.
- Local tissue flaps proved safe and effective in managing these complex wounds.
Implications:
- Local tissue flaps are a safe and effective treatment for posterior wound complications in pediatric spinal instrumentation.
- Avoiding spinal instrumentation removal is crucial to prevent delayed instability.
- Vascularized tissue flaps aid healing, combat infection, and preserve spinal hardware.
Object:
Wound-related complications following complex posterior spine procedures in children may result in the need for serial debridements and may place spinal instrumentation at risk. In this study, the authors review their experience with the management of soft-tissue defects from spinal instrumentation in 5 high-risk pediatric patients. The use of various rotational and transpositional flaps in the management of these complicated cases is discussed, as well as their outcomes.
Methods:
The authors retrospectively reviewed the medical records of 5 patients who returned to the Neuro-Spine service at Texas Children's Hospital for erosion of spinal instrumentation through the skin between September 1, 2007, and October 31, 2012. Patient demographics and clinical and operative data were recorded.
Results:
Risk factors such as young age (1 case), poor nutritional status (1 case), multiple previous surgeries (3 cases), severe neurological deficits (2 cases), and history of radiation therapy for malignancy (2 cases) were noted in the 5 patients. The paraspinous flap (4 cases) was the mainstay of the treatment. Follow-up ranged from 7.5 to 17.5 months (mean 11 ± 4.2 months). One of the patients required more than 1 procedure for revision of the wound. Cultures were positive in 2 of the 5 cases. Spinal instrumentation was removed in 3 of the 5 cases; however, in all 3 of the cases there was evidence of delayed instability that developed after the removal of spinal instrumentation.
Conclusions:
The use of local tissue flaps is safe and efficacious for treatment of posterior wound complications due to spinal instrumentation in children. Removal of spinal instrumentation should be avoided due to the development of delayed instability. Highly vascularized tissue is used to speed healing, clear bacteria, and eliminate dead space, obviating the need to remove contaminated spinal instrumentation.
