Chieng Lee Onn, Hubbard Zachary, Salgado Christopher J, Levi Allan D, Chim Harvey
University of Miami Miller School of Medicine; and.
Division of Plastic Surgery and.
Neurosurg Focus. 2015 Oct;39(4):E17. doi: 10.3171/2015.7.FOCUS15245.
OBJECT A systematic review of the available evidence on the prophylactic and therapeutic use of flaps for the coverage of complex spinal soft-tissue defects was performed to determine if the use of flaps reduces postoperative complications and improves patient outcomes. METHODS A PubMed database search was performed to identify English-language articles published between 1990 and 2014 that contained the following phrases to describe postoperative wounds ("wound," "complex back wound," "postoperative wound," "spine surgery") and intervention ("flap closure," "flap coverage," "soft tissue reconstruction," "muscle flap"). RESULTS In total, 532 articles were reviewed with 17 articles meeting the inclusion criteria of this study. The risk factors from the pooled analysis of 262 patients for the development of postoperative complex back wounds that necessitated muscle flap coverage included the involvement of instrumentation (77.6%), a previous history of radiotherapy (33.2%), smoking (20.6%), and diabetes mellitus (17.2%). In patients with instrumentation, prophylactic coverage of the wound with a well-vascularized flap was shown to result in a lower incidence of wound complications. One study showed a statistically significant decrease in complications compared with patients where prophylactic coverage was not performed (20% vs 45%). The indications for flap coverage after onset of wound complications included hardware exposure, wound infection, dehiscence, seroma, and hematoma. Flap coverage was shown to decrease the number of surgical debridements needed and also salvage hardware, with the rate of hardware removal after flap coverage ranging from 0% to 41.9% in 4 studies. CONCLUSIONS Prophylactic coverage with flaps in high-risk patients undergoing spine surgery reduces complications, while therapeutic coverage following wound complications allows the salvage of hardware in the majority of patients.
对用于覆盖复杂脊柱软组织缺损的皮瓣预防性和治疗性应用的现有证据进行系统评价，以确定皮瓣的使用是否能减少术后并发症并改善患者预后。方法：在PubMed数据库中进行检索，以识别1990年至2014年间发表的英文文章，这些文章包含以下描述术后伤口的短语（“伤口”、“复杂背部伤口”、“术后伤口”、“脊柱手术”）和干预措施（“皮瓣闭合”、“皮瓣覆盖”、“软组织重建”、“肌皮瓣”）。结果：共检索到532篇文章，其中17篇符合本研究的纳入标准。对262例患者进行汇总分析，发现术后需要肌皮瓣覆盖的复杂背部伤口发生的危险因素包括内固定植入（77.6%）、既往放疗史（33.2%）、吸烟（20.6%）和糖尿病（17.2%）。在内固定植入的患者中，用血运良好的皮瓣预防性覆盖伤口可降低伤口并发症的发生率。一项研究显示，与未进行预防性覆盖的患者相比，并发症发生率有统计学显著降低（20%对45%）。伤口并发症发生后皮瓣覆盖的指征包括内固定物外露、伤口感染、裂开、血清肿和血肿。皮瓣覆盖可减少所需的手术清创次数，还能挽救内固定物，4项研究中皮瓣覆盖后内固定物取出率为0%至41.9%。结论：在接受脊柱手术的高危患者中，皮瓣预防性覆盖可减少并发症，而伤口并发症后的治疗性覆盖可使大多数患者的内固定物得以挽救。
