Hultman C Scott, Jones Glyn E, Losken Albert, Seify Hisham, Schaefer Timothy G, Zapiach Louis A, Carlson Grant W
Division of Plastic and Reconstructive Surgery, University of North Carolina, Chapel Hill, NC 27599-7195, USA.
Ann Plast Surg. 2006 Nov;57(5):521-8. doi: 10.1097/01.sap.0000226931.23076.a7.
Infected spinal stabilization devices represent a significant reconstructive challenge by threatening spinal stability and increasing the risk of neurologic complications. This study provides an anatomic and clinical investigation of posterior midline trunk reconstruction using paraspinous muscle flaps as the primary method of repair.
We retrospectively analyzed a series of 25 consecutive patients (mean age, 57.2 years; range, 32-78 years) with complex spinal wounds, reconstructed with paraspinous muscle flaps, at a single university healthcare system. To help define the versatility of these muscle flaps, we also performed cadaveric dissections with lead oxide injections in 10 specimens, with an emphasis on regional blood supply, flap width, and arc of rotation.
From 1994 to 2000, we successfully reconstructed 25 patients with complex spinal wounds, using 49 paraspinous muscle flaps as the primary method of reconstruction. Hardware present in 22 patients was replaced or retained in 17 cases. Long-term spinal fusion with preservation of neurologic status was observed in all patients, with no cases of dehiscence or reinfection. Wound complications included cerebrospinal fluid leak (1), skin necrosis (1), sinus tracts (3), and seroma (2). Mean length of stay was 24 days (range, 8-57 days). One postoperative death occurred. Paraspinous dissections and injections confirmed a segmental type IV blood supply with medial and lateral perforators, arising from intercostal vessels superiorly and lumbar and sacral vessels inferiorly. Flap width was 8 cm at the sacral base, 5 cm at the level of the inferior scapular angle, and 2.5 cm at the first thoracic vertebra.
Paraspinous muscle flaps can be used as the primary reconstructive option to cover and preserve spinal hardware, control local infection, and enable long-term spinal stabilization. Cadaveric dissections confirmed the usefulness of paraspinous flaps, which can be based upon lateral or medial perforators and can be safely mobilized to reliably reconstruct complex spinal wounds.
感染的脊柱内固定装置对脊柱稳定性构成重大重建挑战，并增加神经并发症的风险。本研究对使用椎旁肌瓣作为主要修复方法的后正中躯干重建进行了解剖学和临床研究。
我们回顾性分析了在单一大学医疗系统中，使用椎旁肌瓣重建复杂脊柱伤口的连续25例患者（平均年龄57.2岁；范围32 - 78岁）。为了帮助确定这些肌瓣的多功能性，我们还对10个标本进行了氧化铅注射的尸体解剖，重点关注局部血供、肌瓣宽度和旋转弧。
1994年至2000年，我们成功地使用49个椎旁肌瓣作为主要重建方法，重建了25例复杂脊柱伤口患者。22例患者体内的内固定装置在17例中被更换或保留。所有患者均实现了长期脊柱融合且神经功能得以保留，无裂开或再感染病例。伤口并发症包括脑脊液漏（1例）、皮肤坏死（1例）、窦道（3例）和血清肿（2例）。平均住院时间为24天（范围8 - 57天）。发生1例术后死亡。椎旁解剖和注射证实为节段性IV型血供，有内侧和外侧穿支，分别来自上方的肋间血管和下方的腰血管及骶血管。肌瓣宽度在骶骨基部为8 cm，肩胛下角水平为5 cm，第一胸椎处为2.5 cm。
椎旁肌瓣可作为主要的重建选择，用于覆盖和保留脊柱内固定装置、控制局部感染并实现长期脊柱稳定。尸体解剖证实了椎旁肌瓣的实用性，其可基于外侧或内侧穿支构建，并可安全地游离以可靠地重建复杂脊柱伤口。
