Flap Use for Wound Coverage After Spinal Hardware Infection: A Systematic Review of the Literature

Area of Science:

• Orthopedic Surgery
• Plastic Surgery
• Infectious Disease

Background:

• Spinal defects with surgical site infections (SSIs) are challenging, affecting 1%-4% of spine surgeries.
• SSIs often involve hardware exposure, increasing hospital stays, costs, and poor outcomes.
• Effective management of infected spinal wounds is critical.

Purpose of the Study:

• To systematically review flap reconstruction techniques for spinal defects with surgical site infections.
• To evaluate outcomes including flap survival, necrosis, dehiscence, and infection rates.
• To provide evidence-based insights for managing complex spinal wounds.

Main Methods:

• Systematic review following PRISMA-P guidelines across six databases.
• Included studies reported flap coverage for spinal reconstructions (with or without hardware).
• Quality assessed using ASPS criteria and ROBINS-I tool.

Main Results:

• 32 studies (969 patients) were included; 496 had reconstructions for infected chronic wounds.
• Staphylococcus aureus was the most common organism (52.7%). Paraspinal and latissimus dorsi flaps were most common.
• Pooled flap survival was 89%; muscle flaps (92%) outperformed fasciocutaneous flaps (85%). Complications included wound dehiscence (12%), flap necrosis (8%), and reinfection (10%).

Conclusions:

• Flap reconstruction is a viable solution for soft-tissue coverage in complex spinal defects.
• Muscle flaps demonstrate higher effectiveness compared to fasciocutaneous flaps.
• Tailored surgical planning based on defect and patient factors is essential for successful management.