Muscle Flap Closure Following Complex Spine Surgery: A Decade of Experience.

BACKGROUND Advances in surgical technology and adjuvant therapies along with an aging and increasingly morbid U.S. population have led to an increase in complex spine surgery. With this increase comes an elevated risk of complications including those related to the surgical wound, with some studies demonstrating wound complication incidences approaching 45%. We hypothesize that immediate muscle flap closure improves outcomes in high-risk patients. METHODS Three hundred and one consecutive index cases of spinal wound closure using local muscle flaps performed by the senior author at a single institution between 2006 and 2018 were reviewed. The primary outcome was major wound complication (reoperation and/or readmission due to surgical site infection, late infection, dehiscence, seroma, or hematoma). Logistic regression analysis was performed to identify predictors of this endpoint. RESULTS Major wound complications occurred in 6.6% of patients (3.6% reoperation, 3.0% readmission), with a 6.0% infection rate and five cases requiring instrumentation removal due to infection. Risk factors identified included radiotherapy (OR 5.9, p=0.004), age ≥65 years (OR 2.8, p=0.046), and prior spine surgery (OR 4.3, p=0.027). The incidence of major wound complication increased dramatically with each additional risk factor. Mean drain dwell duration was 21.1±10.0 days and not associated with major wound complications including infection (OR 1.04, p=0.112). CONCLUSIONS Immediate local muscle flap closure following complex spine surgery on high-risk patients is associated with an acceptable rate of wound complications and, as these data demonstrate, is safe and effective. Consideration should be given to immediate muscle flap closure in appropriately selected patients.