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Wound Closure in Nonidiopathic Scoliosis: Does Closure Matter?

Ward, James P. MD; Feldman, David S. MD; Paul, Justin MD, PhD; Sala, Debra A. MS, PT; Errico, Thomas J. MD; Otsuka, Norman Y. MD; Margiotta, Michael S. MD

Journal of Pediatric Orthopaedics: April/May 2017 - Volume 37 - Issue 3 - p 166–170
doi: 10.1097/BPO.0000000000000610

Background: Postoperative wound complications after posterior spinal fusion are difficult to manage. The incidence in the nonidiopathic patient population is significantly higher than the adolescent idiopathic population. A comparison of wound complications after posterior spinal fusion for nonidiopathic scoliosis between the utilization of the orthopaedic surgical team at the time of closure performing a nonstandardized wound closure versus a plastic surgeon with a plastic multilayered closure technique and rotational flap coverage when needed had not previously been evaluated. The purpose of this study was to compare the complication rate between nonstandardized and plastic multilayered closure of the surgical incision in patients undergoing posterior spinal fusion for nonidiopathic scoliosis.

Methods: The charts of 76 patients with a primary diagnosis of scoliosis associated with a syndrome or neuromuscular disease and who underwent a posterior spinal fusion were reviewed. Forty-two patients had their incisions closed using the nonstandardized technique and 34 using the plastic multilayered technique. These 2 groups were compared for age, sex, primary diagnosis, number of levels fused, estimated blood loss, number of units transfused, operating room time, wound complication, and return to operating room.

Results: The wound complication rate in the nonstandardized closure group was 19% (8/42) compared with 0% (0/34) in the plastic multilayered closure group (P=0.007). The unanticipated return to the operating room rate was 11.9% (5/42) for the nonstandardized closure patients versus 0% (0/34) for the plastic multilayered closure patients (P=0.061).

Conclusions: The use of the plastic multilayered closure technique in this patient population is important in an effort to decrease postoperative wound complications. The ability of the surgical team to decrease the infection rate of nonidiopathic scoliosis cannot be overstated. The method of wound closure plays a major role in lowering this incidence.

Level of Evidence: Level III—therapeutic.

*Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases

Department of Plastic and Reconstructive Surgery, NYU Langone Medical Center, New York, NY

T.J.E. has received grants from OMEGA, OREF, Fridolin Trust, AOSpine, and Paradigm; payment for lectures from DePuy and K2M; royalties from K2M; stock/stock options from Fastenetix; travel/accommodations/meeting expenses from K2M. The remaining authors declare no conflicts of interest.

Reprints: David S. Feldman, MD, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 E. 17th Street, New York, NY 10003. E-mail:

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