Muscle Flap Closure following Complex Spine Surgery: A Decade of Experience

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Surgical Innovation

Background:

• Complex spine surgeries are increasing due to technological advances and an aging population.
• High-risk patients undergoing these procedures face elevated risks of surgical wound complications, with some studies reporting incidences up to 45%.

Purpose of the Study:

• To evaluate the efficacy and safety of immediate muscle flap closure in high-risk patients undergoing complex spine surgery.
• To identify predictors of major wound complications in this patient cohort.

Main Methods:

• A retrospective review of 301 consecutive index cases of spinal wound closure using local muscle flaps.
• Analysis of major wound complications (reoperation/readmission for infection, dehiscence, seroma, hematoma) and identification of risk factors using logistic regression.

Main Results:

• Major wound complications occurred in 6.6% of patients, with a 6.0% infection rate.
• Identified risk factors for complications included prior radiotherapy, age 65+, and previous spine surgery.
• No significant association was found between mean drain dwell duration and major wound complications.

Conclusions:

• Immediate local muscle flap closure is a safe and effective method for complex spine surgery in high-risk patients.
• The technique is associated with acceptable rates of wound complications.
• Consideration of immediate muscle flap closure is recommended for appropriately selected patients.