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Paraspinous Muscle Flaps in Complex Pediatric Spine Surgeries: A 12-Year Single Institution Experience
Israel Falade1, Keon Min Park2, Nicole Conkling3
1From the School of Medicine.
Insights
Paraspinal muscle flaps can be safely used in pediatric spine surgery for complex cases. These flaps did not increase complications in high-risk children, suggesting their consideration for improved outcomes.
Area of Science:
- Pediatric Orthopedic Surgery
- Plastic and Reconstructive Surgery
- Wound Management
Background:
- Paraspinal flaps are established for adults but understudied in pediatric spine surgery.
- Limited data exists on the efficacy and safety of paraspinous muscle flap closure in pediatric patients.
Purpose of the Study:
- To compare clinical outcomes of pediatric spine surgery patients with and without paraspinous muscle flap closure.
- To evaluate the utility of paraspinous flaps in complex pediatric spinal cases.
Main Methods:
- Retrospective review of pediatric spine surgeries (2011-2022).
- Two cohorts: paraspinous flap closure vs. no flap closure.
- Patients matched by age, ASA classification, surgical history, and diagnosis.
Main Results:
- 14 patients received paraspinous flaps; 56 served as controls.
- Indications for flaps included complex disease (78.6%) and infection (21.4%).
- No significant difference in postoperative complications, despite higher-risk profiles in the flap group.
Conclusions:
- Paraspinal flaps were used in higher-risk pediatric patients (complex disease, underweight, preoperative infection).
- Flap coverage did not lead to increased postoperative complications.
- Paraspinal muscle flaps are a viable option for high-risk pediatric spine surgery patients.
Purpose:
The benefits of paraspinous flaps in adult complex spine surgery patients are established in the literature; however, their use in pediatric patients has not been well described. This study compares clinical outcomes with and without paraspinous muscle flap closure in pediatric patients who have undergone spine surgery.
Methods:
We conducted a retrospective review of all pediatric spine surgeries at the University of California, San Francisco from 2011 to 2022. Patients were divided into 2 cohorts based on whether the plastic surgery service closed or did not close the wound with paraspinous muscle flaps. We matched patients by age, American Society of Anesthesiology classification, prior spinal surgical history, and diagnosis. Surgical outcomes were compared between the 2 cohorts.
Results:
We identified 226 pediatric patients who underwent at least one spinal surgery, 14 of whom received paraspinous flap closure by plastic surgery. They were matched in a 1:4 ratio with controls (n = 56) that did not have plastic surgery closure. The most common indication for plastic surgery involvement was perceived complexity of disease by the spine surgeon with concern for inadequate healthy tissue coverage (78.6%), followed by infection (21.4%). Postoperative complications were similar between the two groups. The plastic surgery cohort had a higher rate of patients who were underweight (57.1% vs 14.3%, P < 0.01) and had positive preoperative wound cultures (28.6% vs 8.9%, P = 0.05), as well as a higher rate of postoperative antibiotic usage (78.6 vs 17.9%, P < 0.01). There was no difference in recorded postoperative outcomes.
Conclusions:
Spine surgeons requested paraspinous flap closure for patients with more complex disease, preoperative infections, history of chemotherapy, or if they were underweight. Patients with paraspinous flap coverage did not have increased postoperative complications despite their elevated risk profile. Our findings suggest that paraspinous muscle flaps should be considered in high-risk pediatric patients who undergo spine surgery.
