Soft Tissue Reconstruction Of Large Spinal Defects: A 12-year Institutional Experience
Chris Devulapalli, MD, Justin M. Broyles, MD, Ricardo Bello, MD, MPH, Georgia Yalanis, BS, Tarek Y. Elgendy, MBBCh, Richard Redett, MD, Gedge D. Rosson, MD, Justin M. Sacks, MD.
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Purpose: Radical spinal resections can lead to large soft tissue defects requiring reconstruction. Instrumentation, irradiated tissue, and patient comorbidities all increase wound complication risk. The purpose of this study was to review our experience with soft tissue spinal reconstruction and identify risk factors predictive of wound complications.
Methods: We retrospectively reviewed patients who underwent spinal resection and required soft tissue reconstruction from 2002 to 2014. Patient conditions, defect location, indication/method of reconstruction, and wound complication and reoperation rates were collected. Logistic regression was performed to determine risk factors for wound complications.
Results: Of 289 reconstructions performed in 259 patients, 224 were performed prophylactically at time of spinal resection in anticipation of wound complications, and 65 were performed therapeutically for postoperative wound complications. Loco-regional paraspinous muscle flaps were most commonly used (Figure 1). The major wound complication rate (i.e. requiring operative intervention) was similar between prophylactic and therapeutic indications (24.1% v. 15.4%, p=0.136). Patients with prophylactic reconstructions had lower mortality (0.9% v. 9.2%, p<0.001) and instrumentation removal rates (0.9% v. 4.6%, p=0.043). On logistic regression, presence of instrumentation (OR, 3.7; p=0.006), requirement of free flap (OR, 11.3; p=0.041), and age 40-54 (OR, 2.5; p=0.048) were associated with increased major wound complications.
Conclusions: Spinal resections carry significant surgical site morbidity and selection of high-risk patients for prophylactic reconstruction with loco-regional flaps may decrease wound complication rates
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