Single Surgeon Comparison of Midline Versus Overlapping Locoregional Flap Closure Following Spinal Instrumentation.

Area of Science:

• Spine surgery outcomes
• Plastic surgery reconstructive techniques
• Wound closure methods

Background:

• Two paraspinous muscle flap techniques exist for spine surgery closure: midline approximation and aggressive perforator dissection for overlapping.
• No prior studies have compared the surgical outcomes of these two complex spinal closure methods.

Purpose of the Study:

• To compare the surgical outcomes of midline approximation versus overlapping paraspinous muscle flap closure in spine surgery patients.
• To determine if one complex spinal closure technique offers superior results.

Main Methods:

• Retrospective analysis of 110 patients undergoing spine surgery with locoregional muscle flap closure by a single surgeon (Jan 2016-July 2021).
• Patients were divided into two groups based on closure technique: midline approximation or overlapping flaps.
• Multivariable logistic regression with Firth's correction was used to compute odds ratios and confidence intervals, controlling for smoking and postoperative radiation.

Main Results:

• No significant differences in surgical site infection, skin necrosis, dehiscence, hematoma, or seroma were observed between the groups after controlling for covariates.
• The overlapping group had significantly more smokers and higher rates of postoperative radiation.
• Procedure length per centimeter of closure was shorter in the midline approximation group, though not statistically significant (P=0.08).

Conclusions:

• Both overlapping and midline approximation of paraspinous muscle flaps are equally safe and effective for closing spinal wounds.
• Neither complex spinal closure technique demonstrated superiority in preventing common postoperative complications.