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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (5): 910-914. doi: 10.19723/j.issn.1671-167X.2023.05.020

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Plastic and reconstruction surgery for non-healing wound after posterior spinal surgery

Xin-ling ZHANG,Zhi-yu LIN,Yu-jie CHEN,Wen-fang DONG,Xin YANG*()   

  1. Department of Plastic Surgery, Peking University Third Hospital, Beijing 100191, China
  • Received:2021-01-06 Online:2023-10-18 Published:2023-10-09
  • Contact: Xin YANG E-mail:yangxin6@126.com

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Abstract:

Objective: To investigate the clinical significance of different plastic surgeries in the treatment of poor healing wound after posterior spinal internal fixation. Methods: 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. Results: 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 Staphylococcus aureus, 1 case of Pseudomonas aeruginosa, 1 case of Staphylococcus epidermidis, 1 case of Escherichia coli, 1 case of Klebsiella pneumoniae, 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. Conclusion: 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.

Key words: Posterior spinal internal fixation, Non-healing wound, Plastic and reconstruction surgery, Flap reconstruction

CLC Number: 

  • R622.1

Figure 1

Debridement combined with Z-flap repaired the poorly healed incision after posterior spinal internal fixation A, non-healing wounds after posterior spinal approach, ranging from about 8 cm×2 cm; B, design Z-flap; C, thorough debridement; D, immediately after Z-flap repair; E, 2 weeks after Z-flap repair; F, 3 months after Z-flap repair."

Figure 2

Perforator flap of the fourth lumbar artery repaired the poorly healed incision after posterior spinal internal fixation A, perforator flap of the fourth lumbar artery was designed according to the wound of the lower segment of the posterior spine; B, adjust flap size and design flanks according to defect after debridement; C, wound after thorough debridement; D, E, intraoperative rotation of the fourth lumbar artery perforator flap; F, after wound repair with the perforator flap of the fourth lumbar artery."

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