Narrative ReviewCurrent Strategies for Reconstruction of Soft Tissue Defects of the SpineDolan, Roisin T. MD, FCRS Plast*; Butler, Joseph S. PhD, FRCS Tr & Orth†; Vaccaro, Alexander R. MD, PhD, MBA‡; White, Andrew P. MD, FACS§; Giele, Henk P. FRCS, FRACS Plast, MRACMA* Author Information *Department of Plastic & Reconstructive Surgery, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom †National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland ‡Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA §Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA Dr Vaccaro has consulted or has done independent contracting for DePuy, Medtronic, Stryker Spine, Globus, Stout Medical, Gerson Lehrman Group, Guidepoint Global, Medacorp, Innovative Surgical Design, Orthobullets, Ellipse, and Vertex. He has also served on the scientific advisory board/board of directors/committees for Flagship Surgical, AO Spine, Innovative Surgical Design, and Association of Collaborative Spine Research. Dr Vaccaro has received royalty payments from Medtronic, Stryker Spine, Globus, Aesculap, Thieme, Jaypee, Elsevier, and Taylor Francis/Hodder and Stoughton. He has stock/stock option ownership interests in Replication Medica, Globus, Paradigm Spine, Stout Medical, Progressive Spinal Technologies, Advanced Spinal Intellectual Properties, Spine Medica, Computational Biodynamics, Spinology, In Vivo, Flagship Surgical, Cytonics, Bonovo Orthopaedics, Electrocore, Gamma Spine, Location Based Intelligence, FlowPharma, R.S.I., Rothman Institute and Related Properties, Innovative Surgical Design, and Avaz Surgical. He has also served as deputy editor/editor of Spine. In addition, Dr Vaccaro has also provided expert testimony. The remaining authors declare no conflict of interest. Reprints: Roisin T. Dolan, MD, FCRS Plast, Department of Plastic & Reconstructive Surgery, Oxford University Hospitals NHS Trust, Headley Way, Oxford OX3 9DU, United Kingdom (e-mail: roisin.dolan @ouh.nhs.uk). Clinical Spine Surgery: February 2020 - Volume 33 - Issue 1 - p 9-19 doi: 10.1097/BSD.0000000000000936 Buy Metrics Abstract Spinal surgery has been revolutionized by advances in instrumentation, bone graft substitutes, and perioperative care. Extensive dissection, creation of large areas of dead space, and the use of instrumentation in compromised patients, however, predisposes to high rates of wound complications. Postoperative wound complications in patients undergoing complex spinal surgery can have devastating sequelae, including hardware exposure, meningitis, and unplanned reoperation. Recognition of high-risk patients and prediction of wound closure difficulties, combined with preemptive reconstructive surgical strategies may prevent complications. The purpose of this review is to discuss the principles of spine wound management and provide a synopsis of the soft tissue reconstructive strategies utilized in spinal surgery. We review the senior author’s preferred reconstructive algorithm for the management of these complex wounds, in addition to outcomes data relating to the timing of reconstructive surgery. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.