Variability in wound closure technique in midline posterior lumbar fusion surgery. International survey and standardized closure technique proposal

Abstract

Background: Surgical wound complications represent an important risk factor, particularly in multilevel lumbar fusions. However, the literature regarding optimal wound closure techniques for these procedures is limited.

Methods: We performed an online survey of 61 spinal surgeons from 11 countries, involving 25 different hospitals. The study included 26 neurosurgeons, 21 orthopedists, and 14 residents (Neurosurgery - 6 and orthopedics 8). The survey contained 17 questions on demographic information, closure techniques, and the use of drainage in posterior lumbar fusion surgery. We then developed a "consensus technique."

Results: The proposed standardized closure techniques included: (1) using subfascial gravity drainage (i.e., without suction) with drain removal for <50 ml/day or a maximum duration of 48 h, (2) paraspinal muscle, fascia, and supraspinous ligament closure using interrupted-X stitches 0 or 1 Vicryl or other longer-lasting resorbable suture (i.e., polydioxanone suture), (3) closure of subcutaneous tissue with interrupted inverted Vicryl 2-0 sutures in two planes for subcutaneous tissue greater >25 mm in depth, and (4) skin closure with simple interrupted nylon 3-0 sutures.

Conclusion: There is great variability between closure techniques utilized for multilevel posterior lumbar fusion surgery. Here, we have described various standardized/evidence-based proven techniques for the closure of these wounds.

Keywords: Midline posterior lumbar fusion; Spine surgery; Standardized closure; Wound closure.

Figure 1:

(a) Midline posterior lumbar approach. (b) Using subfascial gravity drainage (i.e., without suction) with drain removal for <50 ml/day or a maximum duration of 48 h; paraspinal muscle and fascia closure with an interrupted-X technique of Vicryl 1 or other longer-lasting resorbable suture and include the supraspinous ligament. (c) Closure of subcutaneous tissue with interrupted inverted stitches of Vicryl 2-0 in 1 single plane when depth <25 mm. (d) Two planes for subcutaneous tissue greater > than 25 mm in depth. (e) Skin closure with simple interrupted nylon 3-0 sutures. (f) Standardized closure.