From the School of Medicine.
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA.
Ann Plast Surg. 2024 May 1;92(5):564-568. doi: 10.1097/SAP.0000000000003888. Epub 2024 Mar 26.
The benefits of paraspinous flaps in adult complex spine surgery patients are established in the literature; however, their use in pediatric patients has not been well described. This study compares clinical outcomes with and without paraspinous muscle flap closure in pediatric patients who have undergone spine surgery.
We conducted a retrospective review of all pediatric spine surgeries at the University of California, San Francisco from 2011 to 2022. Patients were divided into 2 cohorts based on whether the plastic surgery service closed or did not close the wound with paraspinous muscle flaps. We matched patients by age, American Society of Anesthesiology classification, prior spinal surgical history, and diagnosis. Surgical outcomes were compared between the 2 cohorts.
We identified 226 pediatric patients who underwent at least one spinal surgery, 14 of whom received paraspinous flap closure by plastic surgery. They were matched in a 1:4 ratio with controls (n = 56) that did not have plastic surgery closure. The most common indication for plastic surgery involvement was perceived complexity of disease by the spine surgeon with concern for inadequate healthy tissue coverage (78.6%), followed by infection (21.4%). Postoperative complications were similar between the two groups. The plastic surgery cohort had a higher rate of patients who were underweight (57.1% vs 14.3%, P < 0.01) and had positive preoperative wound cultures (28.6% vs 8.9%, P = 0.05), as well as a higher rate of postoperative antibiotic usage (78.6 vs 17.9%, P < 0.01). There was no difference in recorded postoperative outcomes.
Spine surgeons requested paraspinous flap closure for patients with more complex disease, preoperative infections, history of chemotherapy, or if they were underweight. Patients with paraspinous flap coverage did not have increased postoperative complications despite their elevated risk profile. Our findings suggest that paraspinous muscle flaps should be considered in high-risk pediatric patients who undergo spine surgery.
文献已经证实了脊柱旁肌皮瓣在成人复杂脊柱手术患者中的益处；然而，其在儿科患者中的应用尚未得到很好的描述。本研究比较了脊柱手术后使用和不使用脊柱旁肌皮瓣闭合的儿科患者的临床结果。
我们对 2011 年至 2022 年期间在加利福尼亚大学旧金山分校进行的所有小儿脊柱手术进行了回顾性研究。根据整形外科服务是否使用脊柱旁肌皮瓣关闭或不关闭伤口，将患者分为两组。我们通过年龄、美国麻醉医师协会分类、既往脊柱手术史和诊断对患者进行匹配。比较两组之间的手术结果。
我们确定了 226 名接受至少一次脊柱手术的小儿患者，其中 14 名患者接受了整形外科的脊柱旁皮瓣闭合。他们与未接受整形外科闭合的对照组（n = 56）以 1:4 的比例匹配。整形外科参与的最常见指征是脊柱外科医生认为疾病复杂，担心健康组织覆盖不足（78.6%），其次是感染（21.4%）。两组术后并发症相似。整形外科组体质量指数较低的患者比例较高（57.1% vs. 14.3%，P < 0.01），术前伤口培养阳性的患者比例较高（28.6% vs. 8.9%，P = 0.05），术后抗生素使用率较高（78.6% vs. 17.9%，P < 0.01）。术后记录的结果无差异。
脊柱外科医生要求对患有更复杂疾病、术前感染、化疗史或体重不足的患者进行脊柱旁皮瓣闭合。尽管风险较高，但接受脊柱旁皮瓣覆盖的患者术后并发症并未增加。我们的研究结果表明，脊柱旁肌皮瓣应考虑用于接受脊柱手术的高危儿科患者。
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