Drain burden and postoperative complications in paraspinous muscle flap reconstruction: A retrospective cohort study

Paraspinous muscle flaps (PSMF) remain a workhorse option for posterior spinal wound reconstruction and they provide reliable and well-vascularized local tissue. Drain placement has historically been treated as a routine adjunct to this procedure; however, procedure-specific evidence is limited, and emerging data suggest that drain use may carry its own risks.We conducted a retrospective cohort study of 191 consecutive patients who underwent PSMF reconstruction at a single tertiary-care center between July 2017 and January 2025. Patients were categorized by flap technique used: superficial release (n = 33), deep release (n = 106), or combined release (n = 52). Drain utilization, complications, and mortality were compared across the groups. Drain placement varied significantly by technique (p < 0.001), occurring in 93.9% of superficial, 88.5% of combined, and only 30.2% of deep release cases. The overall complication rate was 23.6%, with no significant difference across the techniques (p = 0.17). Complication rates rose with drain burden: 15.9% with 0, 25.6% with 1, 42.9% with 2, and 50.0% with 3 drains. In the principal multivariable analysis, each additional drain was independently associated with higher odds of postoperative complications (OR 1.83; 95% CI, 1.06-3.16; p = 0.030), as were prior radiation and preoperative infection; this association was attenuated in expanded and time-to-event models.These findings support reframing of drain placement from an assumed component of PSMF reconstruction to a perioperative management variable that warrants deliberate, indication-aware use.