The Utility of Prophylactic Muscle Flaps in Complex Pediatric Spine Surgery
Wesley Q Zhang1, Ashlie A Elver2, Laura S Humphries2
1School of Medicine, University of Mississippi Medical Center.
Insights
Prophylactic paraspinal muscle flaps in pediatric spine surgery did not significantly improve outcomes after accounting for patient risk. Careful patient selection is key, as flaps may benefit higher-risk individuals needing complex procedures.
Area of Science:
- Pediatric surgery
- Orthopedic surgery
- Surgical outcomes
Background:
- Complex pediatric spinal surgery carries significant risks.
- Paraspinal muscle flaps are used post-complication for wound closure.
- Prophylactic use of flaps during initial surgery is debated.
Purpose of the Study:
- To evaluate the effectiveness of prophylactic paraspinal muscle flaps in pediatric spine surgery.
- To compare surgical site infections and wound complications between patients with and without prophylactic flaps.
Main Methods:
- Retrospective cohort study using the Pediatric National Surgical Quality Improvement Program (PNSQIP) database (2016-2021).
- Compared outcomes of pediatric spinal surgery patients with and without prophylactic paraspinal flaps.
- Utilized regression modeling and propensity score matching to control for baseline differences.
Main Results:
- Higher comorbidities and complication rates (surgical site infection, wound disruption) were observed in the flap group.
- Flaps were more common in higher-risk patients (e.g., ASA class).
- After propensity score matching, no significant differences in outcomes were found between groups.
Conclusions:
- Prophylactic muscle flaps may be beneficial for carefully selected, high-risk pediatric patients undergoing complex spinal surgery.
- Patient selection appears crucial in determining the utility of prophylactic flaps.
Purpose:
Complex spinal surgery in the pediatric population can lead to devastating complications and morbidity. Paraspinal muscle flaps are commonly performed after complications to optimize wound closure. However, some advocate for their prophylactic use at the index surgery. The aim of this study is to determine the utility of prophylactic muscle flaps in pediatric spine surgery.
Methods:
A retrospective cohort study was performed using data from the Pediatric National Surgical Quality Improvement Program (PNSQIP) database. Patients who underwent complex spinal surgery from 2016 to 2021 were queried and split into cohorts based on whether muscle flaps were performed at the index surgery. Primary outcomes compared the incidence of surgical site infections (SSI) and wound complications. Regression modeling and propensity score matching were performed to account for baseline characteristics.
Results:
There were 43,678 patients who underwent spinal surgery. Of these, 847 (1.9%) had concomitant paraspinal flaps. Comorbidities were significantly higher in the flap group. Overall SSI, deep and organ space SSI, and wound disruption were higher in flap patients ( P <0.001). Muscle flaps were performed more in high-risk patients determined by ASA (American Society of Anesthesiologists) class, and these patients experienced significantly more complications overall (rate of SSI- ASA 1: 1.1% versus ASA 4: 5.6%; P <0.001). When propensity score matching was controlled for baseline characteristics, there were no significant differences in outcomes.
Conclusions:
Patient selection may determine the need for prophylactic muscle flaps, favoring more complex patients. These patients may experience more complications, supporting the decision to perform a muscle flap at the time of index operation.
