Book chapter
172 - Spinal Wound Closure
Benzel's Spine Surgery, pp.1507-1516.e2
Elsevier Inc, Fifth Edition
2022
DOI: 10.1016/B978-0-323-63668-1.00172-5
Abstract
To effectively manage spinal wounds, one must have a strong understanding of the soft tissue anatomy of the back. The basis for avoiding spinal wound complications relies on basic surgical principles, such as a clean, vascularized wound, organized layered closure, and optimization of patient wound healing factors. Vancomycin powder applied during primary closure has been effective in reducing surgical site infection. If a wound complication occurs, local bedside wound care with microdebriding dressings and antibacterial ointments can help in the closure of less complicated spinal wounds. Negative pressure dressings, also called vacuum-assisted closure systems, have been used with success in chronically nonhealing clean or mildly infected wounds. Hyperbaric oxygen therapy may also be indicated for the treatment of nonhealing or infected wounds. The high tissue oxygen tensions are believed to increase angiogenesis and neutrophil function. Paraspinous muscle flaps are an excellent first choice for coverage of exposed bone or hardware at the midline following primary or secondary closure. The trapezius flap may be used for defects of the upper third of the thoracic spine and, because of its relatively expansive length and width, can cover a relatively wide arc of rotation. The latissimus dorsi muscle can be used to provide muscle-only or myocutaneous flaps for the closure of spinal defects over the lower thoracic or lumbar spine. Unilateral or bilateral gluteus maximus flaps are useful in nonambulatory patients for the closure of sacral or ischial sores.
Details
- Title: Subtitle
- 172 - Spinal Wound Closure
- Creators
- Nahom TeferiAli R AbtahiMark D. FisherPatrick W. Hitchon
- Resource Type
- Book chapter
- Publication Details
- Benzel's Spine Surgery, pp.1507-1516.e2
- Edition
- Fifth Edition
- DOI
- 10.1016/B978-0-323-63668-1.00172-5
- Publisher
- Elsevier Inc; Philadelphia, PA
- Language
- English
- Date published
- 2022
- Academic Unit
- Surgery; Neurosurgery
- Record Identifier
- 9984643657202771
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