Zhang Xin Ling, Lin Zhi Yu, Chen Yu Jie, Dong Wen Fang, Yang Xin
Department of Plastic Surgery, Peking University Third Hospital, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2023 Oct 18;55(5):910-914. doi: 10.19723/j.issn.1671-167X.2023.05.020.
To investigate the clinical significance of different plastic surgeries in the treatment of poor healing wound after posterior spinal internal fixation.
In this study, 16 patients with poor incision healing after posterior spinal internal fixation were retrospectively included, and dif-ferent plastic surgery treatment plans were determined according to the wound characteristics and defect condition. The measures included debridement, vacuum sealing drainage (VSD), and different tissue flaps according to the location and extent of the defect.
A total of 16 patients meeting the criteria were included, of whom 3 were treated with debridement combined with VSD and wound suture directly, 6 were treated with debridement combined with Z-flap for wound repair, 1 was treated with bilateral sacrospinous muscle flap for dural defect repair combined with Z-flap for skin wound repair, 1 was treated with lectus dorsi flap for wound repair, 3 were treated with the fourth lumbar artery perforator flap for wound repair. The wound was repaired with local rotating flap in 1 case and gluteus maximus musculocutaneous flap in 1 case. Among the 16 patients, 7 cases were positive for wound culture, including 3 cases of , 1 case of , 1 case of , 1 case of , 1 case of , and the other 9 cases were negative. After surgery, there were 7 patients with different degrees of poor wound healing, including 3 patients undergoing dressing change, 2 patients undergoing secondary debridement and suture, 1 patient undergoing free scalp skin graft, and 1 patient undergoing local effusion suction treatment. All the above 7 patients were discharged from hospital after improvement, and the remaining 9 patients had good first-stage wound hea-ling after surgery. None of the 16 patients underwent internal fixation.
Multiple factors could lead to poor wound healing after posterior spinal internal fixation. Early intervention, thorough debridement, removal of necrotic/infected tissue, and selection of suitable skin flap for effective wound fil-ling and covering were important means to ensure wound healing after spinal surgery and reduce removal of internal fixation.
探讨不同整形手术在治疗脊柱后路内固定术后愈合不良伤口中的临床意义。
本研究回顾性纳入16例脊柱后路内固定术后切口愈合不良的患者，根据伤口特点和缺损情况确定不同的整形手术治疗方案。措施包括清创、封闭式负压引流（VSD），以及根据缺损部位和范围采用不同的组织瓣。
共纳入16例符合标准的患者，其中3例采用清创联合VSD并直接缝合伤口，6例采用清创联合Z形皮瓣修复伤口，1例采用双侧骶棘肌瓣修复硬脊膜缺损并联合Z形皮瓣修复皮肤伤口，1例采用背阔肌瓣修复伤口，3例采用第四腰动脉穿支皮瓣修复伤口。1例采用局部旋转皮瓣修复伤口，1例采用臀大肌肌皮瓣修复伤口。16例患者中，7例伤口培养阳性，包括3例[具体菌种1]、1例[具体菌种2]、1例[具体菌种3]、1例[具体菌种4]、1例[具体菌种5]，其余9例为阴性。术后，7例患者出现不同程度的伤口愈合不良，其中3例进行换药，2例进行二次清创缝合，1例进行游离头皮植皮，1例进行局部积液抽吸治疗。上述7例患者均好转出院，其余9例患者术后一期伤口愈合良好。16例患者均未取出内固定。
多种因素可导致脊柱后路内固定术后伤口愈合不良。早期干预、彻底清创、清除坏死/感染组织，以及选择合适的皮瓣进行有效的伤口填充和覆盖是确保脊柱手术后伤口愈合及减少内固定取出的重要手段。
