Reconstruction with muscle flaps after hip joint heterotopic ossification resection in spinal cord injured patients:...

Heterotopic ossification (HO) is a frequent complication in persons with spinal cord injury (SCI). This condition leads to limitations in movement and to abnormal posture, which can impair sitting and bed positioning and may result in pressure ulcers. Surgery is considered when HO causes severe limitations due to joint obstruction caused by the ossification. However, the defect left after resection is often extensive and may create significant dead spaces that can lead to seroma or hematoma formation if not adequately filled, increasing the risk of infection and prolonged hospitalization, and extended antibiotic therapy.

We report five cases of large HO treated with resection followed by muscle flap reconstruction to eliminate all dead spaces. All patients were male, with a median age of 44 years old; 3 patients were paraplegic and 2 tetraplegics; 3 patients presented with AIS A and 2 with AIS B. All HOs were in the trochanteric region and involve the hip joint, with a mean defect size of 9,6 × 39,7 × 9,4 cm. After HO resection the defects were filled with a rectus femoris muscle flap. In two cases we observed a seroma that was drained, and the defect was filled with another muscle flap (vastus lateralis and semimembranosus).

In all reported cases, following muscle flap positioning, no seromas or hematomas were observed. We believe that this reconstructive technique can be beneficial in such cases and may become part of our standard approach to HO resection.