Prophylactic Muscle Flaps Decrease Wound Complication Rates in Patients with Oncologic Spine Disease.
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2024-01
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Abstract
Background
Patients with oncologic spine disease face a high systemic illness burden and often require surgical intervention to alleviate pain and maintain spine stability. Wound healing complications are the most common reason for reoperation in this population and are known to impact quality of life and initiation of adjuvant therapy. Prophylactic muscle flap (MF) closure is known to reduce wound healing complications in high-risk patients; however, the efficacy in oncologic spine patients is not well established.Methods
A collaboration at our institution presented an opportunity to study the outcomes of prophylactic MF closure. The authors performed a retrospective cohort study of patients who underwent MF closure versus a cohort who underwent non-MF closure in the preceding time. Demographic and baseline health data were collected, as were postoperative wound complication data.Results
A total of 166 patients were enrolled, including 83 patients in the MF cohort and 83 control patients. Patients in the MF group were more likely to smoke ( P = 0.005) and had a higher incidence of prior spine irradiation ( P = 0.002). Postoperatively, five patients (6%) in the MF group developed wound complications, compared with 14 patients (17%) in the control group ( P = 0.028). The most common overall complication was wound dehiscence requiring conservative therapy, which occurred in six control patients (7%) and one MF patient (1%) ( P = 0.053).Conclusions
Prophylactic MF closure during oncologic spine surgery significantly reduces the wound complication rate. Future studies should examine the precise patient population that stands to benefit most from this intervention.Clinical question/level of evidence
Therapeutic, III.Type
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Dalton, Tara, Grant Darner, Edwin McCray, Meghan Price, Cesar Baëta, Melissa Erickson, Isaac O Karikari, Muhammad M Abd-El-Barr, et al. (2024). Prophylactic Muscle Flaps Decrease Wound Complication Rates in Patients with Oncologic Spine Disease. Plastic and reconstructive surgery, 153(1). pp. 221–231. 10.1097/prs.0000000000010568 Retrieved from https://hdl.handle.net/10161/31363.
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Melissa Maria Erickson
I am a spine surgeon who provides surgical management of cervical, thoracic and lumbar spine conditions, including cervical myelopathy, herniated discs, deformity, stenosis, tumor and trauma. I provide both minimally invasive procedures as well as traditional surgical techniques.
Muhammad Abd-El-Barr
As a Neurosurgeon with fellowship training in Spine Surgery, I have dedicated my professional life to treating patients with spine disorders. These include spinal stenosis, spondylolisthesis, scoliosis, herniated discs and spine tumors. I incorporate minimally-invasive spine (MIS) techniques whenever appropriate to minimize pain and length of stay, yet not compromise on achieving the goals of surgery, which is ultimately to get you back to the quality of life you once enjoyed. I was drawn to medicine and neurosurgery for the unique ability to incorporate the latest in technology and neuroscience to making patients better. I will treat you and your loved ones with the same kind of care I would want my loved ones to be treated with. In addition to my clinical practice, I will be working with Duke Bioengineers and Neurobiologists on important basic and translational questions surrounding spinal cord injuries (SCI), which we hope to bring to clinical relevance.
David Andrew Brown
David A. Brown, M.D., Ph.D. is Associate Professor of Surgery and Vice Chief of Research in the Division of Plastic, Maxillofacial, and Oral Surgery at Duke University. Dr. Brown is originally from Colorado and studied engineering at the University of Colorado followed by a Ph.D. in biomedical engineering at UCLA. He subsequently attended medical school at UC Irvine and went on to complete general surgery residency at University of Washington Medical Center followed by plastic surgery residency at Duke University Medical Center. Dr. Brown practices general reconstructive surgery, including the surgical treatment of skin defects resulting from cancer, infection, and trauma. His clinical interests include targeted muscle reinnervation, soft tissue reconstruction of the back, and complex wound healing. He is an NIH-funded researcher exploring mechanisms of limb and digit regeneration in mammals with the hope of one day applying regeneration-based therapies to human diseases. He is the medical director of the Duke Wound Healing Clinic and co-director of the Duke Regeneration Center. Dr. Brown is a Fellow of the American College of Surgeons and is board-certified by the American Board of Surgery, the American Board of Plastic Surgery, and the American Board of Wound Management.
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