Rotational and transpositional flaps for the treatment of spinal wound dehiscence and infections in patient populations with degenerative and oncological disease.

Abstract

Wound-related complications following complex posterior spine procedures may result in the need for serial debridements and may place the instrumentation at risk. Numerous treatments have been advocated for this problem, but each has limitations. In this article the authors discuss the experience from two large teaching institutions at which rotational and transpositional flaps were used in the management of deep wound infections and dehiscences. The authors generated a list of patients treated via posterior or posterolateral approaches for metastatic tumors or complex degenerative disorders in whom wound complications subsequently developed. Data were obtained from the medical records and reviewed retrospectively. Thirty-seven patients were treated with rotational or transpositional flaps at the two institutions during the study period. Patients underwent a mean of 1.3 procedures for the treatment of wound healing problems, and cultures were positive in 70%. In three patients (8%) this treatment failed due to protrusion of hardware through the skin or repeated dehiscence requiring reclosure. Spinal instrumentation was salvaged in 97% of the cases. The use of local tissue flaps is advantageous for treatment of posterior wound complications due to spine surgery. In this procedure highly vascularized tissue is used to increase healing, accelerate clearance of bacteria, and fill any dead space.