Local muscle flaps minimize post-operative wound morbidity in patients with neoplastic disease of the spine

Abstract

Objectives: Patients with neoplastic disease involving the spine either from primary or metastatic disease present a unique challenge given these patients' frequent poor nutritional status at the time of surgery, the delivery of early post-operative chemotherapy or radiation, and placement of large amounts of hardware and avascular bone graft into a wound bed that is atrophic, previously operated or irradiated. As a result, wound morbidity has traditionally been high in this cohort of patients. Herein we review the outcomes of patients at our institution who underwent local muscle flap closure following spinal tumor extirpation.

Patients and methods: Between 2007 and 2017, 55 patients with oncologic disease of the spine underwent 60 spine surgeries and concomitant muscle flap reconstruction. Charts were retrospectively reviewed for diagnosis and indications for surgery, as well as risk factors for poor wound healing including diabetes, steroid use, body mass index (BMI), history of pre-operative chemo and or radiation therapy, preoperative albumin and hemoglobin levels. Outcomes were postoperative wound related complications including surgical site infection, wound dehiscence and/or need for reoperation.

Results: 60 reconstructions were included in 55 patients. Median follow up was 253 days. Paraspinous muscle flaps were used in all cases. There were 2 major complications (3.3%) related to wound infections which required reoperation and 10 minor wound complications (16.7%), of which 9 were subcutaneous seromas aspirated in the office, that did not require return to the operating room. Median postoperative stay in the hospital was 10 days. Closed suction drains placed at the end of the reconstruction were removed at a median of 17.5 days. Regression analysis found patient BMI to be a significant risk predictor for wound related post-operative complications.

Conclusions: Post-operative wound specific complications that required return to the operating room were uncommon despite the high-risk profile of this subset of patients. These data indicate that muscle flap closure should be routinely practiced in this high-risk cohort of patients.

Keywords: Local flap; Muscle flap reconstruction; Neoplasm of spine; Spinal wound.