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Soft-Tissue Reconstruction of Large Spinal Defects: A 12-Year Institutional Experience

Devulapalli, Chris M.D.; Broyles, Justin M. M.D.; Bello, Ricardo M.D., M.P.H.; Elgendy, Tarek M.D.; Yalanis, Georgia B.S.; Redett, Richard M.D.; Rosson, Gedge D. M.D.; Sacks, Justin M. M.D.

Plastic and Reconstructive Surgery: October 2017 - Volume 140 - Issue 4 - p 806-814
doi: 10.1097/PRS.0000000000003679
Reconstructive: Trunk: Original Article
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Coding Perspective

Background: Spinal resections can lead to defects requiring soft-tissue reconstruction. The purpose of this study was to review the authors’ institutional experience with reconstruction of spinal defects and identify risk factors predictive of wound complications, focusing on timing of reconstruction with ablative surgery.

Methods: The authors retrospectively reviewed patients who underwent spinal resection and required soft-tissue reconstruction from 2002 to 2014. Logistic regression was performed to identify risk factors for complications.

Results: Of 289 reconstructions performed in 259 patients, 64 cases (22.1 percent) had major wound complications requiring reoperation. Lumbosacral defects were the most common location (43.6 percent) and paraspinous muscle flaps were the preferred reconstructive method used for all defect regions. A total of 224 reconstructions (77.5 percent) were performed immediately at the time of spinal surgery, and 65 (22.5 percent) were performed in delayed fashion as a result of wound complications from previous spinal surgery. Patients undergoing immediate reconstruction had significantly lower rates of instrumentation removal (0.9 percent versus 4.6 percent; p = 0.043), unplanned reoperations (0.5 versus 1.3; p < 0.001), and mortality (0.9 percent versus 9.2 percent; p < 0.001) compared with those undergoing delayed reconstruction. On logistic regression analysis, presence of instrumentation (OR, 3.2; p = 0.012), requirement for a free flap (OR, 9.0; p = 0.016), and spinal cord exposure (OR, 2.6; p = 0.036) were associated with increased odds of a major wound complication.

Conclusion: Spinal resections carry significant surgical-site morbidity, and selection of high-risk patients for immediate reconstruction with locoregional muscle flaps may be beneficial for improving wound-related outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Coding Perspective for this Article is on Page 813.

Baltimore, Md.

From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital.

Received for publication August 5, 2016; accepted March 31, 2017.

Presented at the 61st Annual Meeting of the Plastic Surgery Research Council, in New York, New York, May 19 through 22, 2016.

Disclosure:Justin Sacks is a speaker/consultant for LifeCell Corporation. All other authors have no financial interest to declare in relation to the content of this article. No external funding was received.

Justin M. Sacks, M.D., Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Suite 2114C, Baltimore, Md. 21201

Copyright © 2017 by the American Society of Plastic Surgeons