Local muscle flaps in the setting of revision spine surgery: Indications, operative planning, principles, and postoperative management
An increasing body of literature demonstrates that wound morbidity after complex spine reconstruction is significantly reduced by the immediate coverage of the operated spine with local muscle flaps. The only contraindication to wound closure with local muscle flaps is if the patient is unable to tolerate the marginal anesthesia time needed for flap closure, whether because of existing comorbidities and perioperative cardiac risk or because of intraoperative complications or hemodynamic instability. Preservation of the blood supply to the skin and underlying musculature sometimes can be challenging in the setting of revision surgery due to the presence of scars from prior surgeries, each of which interrupts blood flow. The literature is clear that patients who undergo reoperative spine reconstruction with muscle flaps experience fewer postoperative wound healing complications and, when such complications do occur, they are more likely to recover with nonoperative intervention.