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Review
. 2021 Feb;35(1):3-9.
doi: 10.1055/s-0041-1722852. Epub 2021 May 10.

The Historical Role of the Plastic Surgeon in Spine Reconstruction

Annie Do  1 , Matthew J Davis  2   3 , Amjed Abu-Ghname  2   3 , Sebastian J Winocour  2 , Edward M Reece  2   3 , Scott Holmes  4 , David S Xu  5 , Alexander E Ropper  5 , Scott L Hansen  1
Affiliations
Review

The Historical Role of the Plastic Surgeon in Spine Reconstruction

Annie Do et al. Semin Plast Surg. 2021 Feb.

Abstract

Wound complications occur in up to 19% of patients undergoing complex spine surgery. The role of the plastic surgeon in complex and redo spine surgery is important and evolving. Classically, plastic surgeons have been involved in the management of patients who develop wound complications following surgery. This involves reconstruction of posterior trunk defects with locoregional fasciocutaneous, muscle, and free tissue transfers. There has also been an increasing role for plastic surgeons to become involved in prophylactic closures of complex and/or redo spine surgeries for high-risk populations. Identification of patients with comorbidities and likelihood for multiple reoperations who are prophylactically treated with complex closure with or without local muscle flaps could significantly decrease the postoperative wound complications.

Keywords: complex closure; complications; plastic surgery; spine surgery.

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Conflict of interest statement

Conflicts of Interest Dr. Hansen is part of the Speakers Bureau for Smith and Nephew, but this commitment has no conflict with this report.

Figures

Fig. 1
Fig. 1
Open spinal wound with exposed hardware.
Fig. 2
Fig. 2
Open, draining spinal wound.
Fig. 3
Fig. 3
The reconstructive ladder. Reprinted with permission of Baylor College of Medicine.
Fig. 4
Fig. 4
Cross-section of paraspinous advancement flap. ( A ) Medial dissection. ( B ) Lateral dissection. ( C ) Advancement and closure of bilateral paraspinous muscle flaps over spinal hardware. Reprinted with permission of Baylor College of Medicine.
Fig. 5
Fig. 5
Case example of paraspinous advancement flap. ( A ) Vancomycin powder placed over exposed spinal hardware. ( B ) Advancement and closure of bilateral paraspinous muscle flaps. ( C ) Skin closure.
Fig. 6
Fig. 6
Diagram of trapezius flap. Reprinted with permission of Baylor College of Medicine.
Fig. 7
Fig. 7
Case example of trapezius muscle flap to cover exposed cervical spinal hardware. ( A ) Exposed cervical spinal hardware. ( B ) Intraoperative exposure. ( C ) Trapezius muscle flap prior to inset. ( D ) Inset of trapezius muscle flap to cover cervical operative levels. ( E ) Postoperative closure.
Fig. 8
Fig. 8
Case example of arteriovenous (AV) loop. ( A ) Staged island flap. ( B ) Formation of AV loop. ( C ) Anastomosis of island flap to AV loop.
Fig. 9
Fig. 9
Summary diagram demonstrating how the management of spinal defects depends on the anatomic location of the defect. Reprinted with permission of Baylor College of Medicine.
See this image and copyright information in PMC

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