Muscle flap closure for salvage of complex back wounds

The use of muscle flaps for closing complex thoracolumbar and lumbar spine wounds was studied retrospectively. Five patients in whom traditional, conservative treatment modalities did not work underwent a variety of muscle flap closures with successful healing.

Patients with complicated back wounds ranging from exposed hardware to post-traumatic defects were treated initially with conservative treatments. The authors evaluated the efficacy of applying techniques and knowledge gained from complex lower extremity wound coverage of back wounds.

Six muscle transfer procedures were performed on five patients. All patients were closed with local muscle flaps using the trapezius and latissimus dorsi muscles.

Success was defined as a closed stable wound that needed no future surgery nor allowed the primary defect to heal before hardware removal. There was no evidence of chronic infection. Surgical hardware was salvaged in one of three patients.

All were successfully closed and have been followed up to 30 months without evidence of recurrence.

The cases presented illustrate the usefulness of rotation flaps when there is an extensive soft tissue defect that has exposed neural, osseous, and foreign structures. The use of local transposition muscle flaps as an adjunct in closing complex back wounds has been very successful in our experience. Although recurrent infection may occur, this technique has facilitated the establishment of a soft tissue envelope to achieve short- and long-term wound healing.