Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA.
Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA; Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
World Neurosurg. 2024 May;185:e915-e925. doi: 10.1016/j.wneu.2024.02.151. Epub 2024 Mar 6.
Soft tissue defects and persistent cerebrospinal fluid (CSF) leaks can create complications after cervical spinal surgery. The supraclavicular artery island (SAI) flap is useful in closing tissue defects, particularly in these complex surgeries and multiple reinterventions. However, technical reports in this context are scarce. We describe application of the SAI flap technique to control persistent CSF leak in the first documented instance (to our knowledge) of a low-grade fibromyxoid sarcoma (LGFMS) in the cervical epidural space. Additionally, we conducted a comprehensive review of PubMed, Embase, and Google Scholar from their earliest records through December 17, 2023 using combined terms, "supraclavicular artery island flap AND spine" and "supraclavicular AND flap AND spine".
A 56-year-old woman with arm pain and weakness presented with a cervical epidural mass extending from C4-C6 and associated spinal cord compression. She underwent a 3-level corpectomy and tumor resection. Primary dural closure was impossible due to the dural invasion, and reintervention with an SAI flap and definitive lumboperitoneal shunting were required to control and seal the CSF leak.
Seven case reports describing SAI flap for spinal surgery complications were identified. The indications in those cases were correcting esophageal and hypopharyngeal perforations after cervical fusion and discectomy and persistent soft tissue coverage after cervical instrumentation.
The SAI flap technique provided wound defect coverage in this case and is suitable for addressing issues such as persistent CSF leaks or soft tissue coverage after cervical spine surgery.
颈椎手术后，软组织缺损和持续的脑脊液（CSF）漏会导致并发症。锁骨上动脉岛（SAI）皮瓣在闭合组织缺损方面非常有用，尤其是在这些复杂的手术和多次再干预中。然而，在这方面的技术报告却很少。我们描述了在首例（据我们所知）颈椎硬膜外间隙低度纤维粘液样肉瘤（LGFMS）中应用 SAI 皮瓣技术控制持续性 CSF 漏的情况。此外，我们通过联合术语“锁骨上动脉岛皮瓣和脊柱”和“锁骨上和皮瓣和脊柱”，对 PubMed、Embase 和 Google Scholar 进行了全面的文献回顾，检索时间为最早记录至 2023 年 12 月 17 日。
一名 56 岁女性，因手臂疼痛和无力就诊，发现颈椎硬膜外有一个从 C4 到 C6 延伸的肿块，并伴有脊髓压迫。她接受了 3 个节段的椎体切除术和肿瘤切除术。由于硬脑膜侵犯，直接缝合硬脑膜不可能，需要再次干预应用 SAI 皮瓣和最终的腰腹腔分流术来控制和密封 CSF 漏。
确定了 7 例描述 SAI 皮瓣用于脊柱手术并发症的病例报告。这些病例的适应证为颈椎融合和椎间盘切除术后食管和咽鼓管穿孔的矫正，以及颈椎器械固定后持续的软组织覆盖。
在这种情况下，SAI 皮瓣技术提供了创面缺损覆盖，适用于解决颈椎手术后持续 CSF 漏或软组织覆盖等问题。
