Technical versatility of pedicled latissimus dorsi-based flaps for refractory spinal CSF leaks

Persistent cerebrospinal fluid (CSF) leakage following spinal surgery or congenital spinal reconstruction can result in pseudomeningocele, meningitis, wound breakdown, and exposed instrumentation. Management is particularly challenging after multiple operations or in the presence of poor-quality local tissue. When primary dural repair and conventional wound-management strategies fail, vascularized tissue transfer may be required to reinforce the dura, obliterate dead space, and promote durable healing.

We report three patients with refractory spinal CSF leakage treated with pedicled latissimus dorsi-based flaps after failure of conventional treatment. Different flap configurations were selected according to defect location and reconstructive requirements, including a pedicled musculocutaneous flap, an extended muscle flap with fascial extension, and bilateral muscle advancement flaps with fascial extension.

All flaps survived and all CSF leaks resolved. Wound healing was achieved without major flap-related complications. Minor complications included seroma and limited skin-edge necrosis. Long-term follow-up was available in two patients at 2 years, demonstrating durable soft-tissue coverage without recurrent CSF leakage.

Pedicled latissimus dorsi-based flaps represent a versatile salvage option for selected refractory spinal CSF leaks when primary dural repair and local reconstructive options are insufficient. Their configuration can be adapted to provide vascularized dural reinforcement and dead-space obliteration across different spinal levels.