Use of the reverse latissimus muscle flap for closure of complex back wounds in patients with spinal cord injury.

摘要

STUDY DESIGN: Our study was designed as a retrospective review of spinal cord patients with complex back wounds in whom the reverse latissimus muscle flap was used for closure. OBJECTIVES: The objective was to evaluate the efficacy and outcomes in these patients. SUMMARY OF BACKGROUND DATA: Earlier publications give only anecdotal reports on the treatment of complex back wounds in patients with spinal cord syndrome. The data so far available do not allow any comparison of the various methods used. METHODS: Fourteen patients with congenital or acquired spinal cord syndrome and with an average age of 31.2 years (range 12-76 years) had complex back wounds in the thoracic and lumbar regions, which were closed in each case with a reverse latissimus dorsi muscle flap. The patients had deep wound infection and wound dehiscence following spondylodesis (n = 6), dead space and wound dehiscence following laminectomy (n = 6), or decubitus ulcers over the spine (n = 2). The spinal cord syndrome was chronic in nine patients and acute in five. The pre- and postoperative treatment and the actual operation were all done in a spinal cord injury center. In nine patients, the back wound was closed in a primary procedure, and in five, a split-thickness skin graft was used to close it. In 11 patients, primary wound healing was achieved with no complications after closure, whereas in 3 patients, complications with the back wound or the donor site led to disturbances of wound healing lasting up to 25 weeks. Five operations had to be performed specifically because of these complications. RESULTS: At follow-up 27.4 months (mean; range 8-114 months) after the operation, all back wounds were closed, free of irritation, and completely healed. The patients did not report any handicaps in everyday life, loss of strength in the upper extremities, or functional restrictions. One patient had a deep vein thrombosis in one leg. No further complications linked with the spinal cord syndrome were ascertained. The instrumentation used during thespondylodesis operation was left in place in four cases. The spondylodesis became solidly fused in each of these cases. CONCLUSION: Use of the reverse latissimus muscle flap is a reliable method of closing complex back wounds in patients with spinal cord syndrome. Should there be complications in the area of the flap, secondary wound healing can be achieved by wound debridement and closure of the wound by means of split-thickness skin grafting. There is no loss of function in the upper extremities. The complications typically seen in spinal cord patients can be avoided when the treatment is carried out in the conditions that obtain in a specialized spinal cord injury center.