Management of radiated reoperative wounds of the cervicothoracic spine: The role of the trapezius turnover flap Journal Article

Authors: Disa, J. J.; Smith, A. W.; Bilsky, M. H.
Article Title: Management of radiated reoperative wounds of the cervicothoracic spine: The role of the trapezius turnover flap
Abstract: Reoperation for malignant disease of the cervicothoracic spine can lead to compromised wound healing secondary to poor tissue quality from previous operations, heavily irradiated beds, and concomitant steroid therapy. Other complicating factors include exposed dura and spinal implants. Introducing well-vascularized soft tissue to obliterate dead space is critical to reliable wound healing. The purpose of this study was to determine the efficacy of the trapezius turnover flap in the management of these complex wounds. This study is a retrospective review of all patients undergoing trapezius muscle turnover flaps for closure of complex cervicothoracic wounds after spinal operations for metastatic or primary tumors. Six patients (3 male/3 female) were operated over an 18-month period (mean patient age, 43 years). Primary pathologies included radiation-induced peripheral nerve sheath tumor (N=2), chondrosarcoma (N=1), nonsmall-cell lung cancer (N=1), paraganglioma (N=1), and spindle cell sarcoma (N=1). Trapezius muscle turnover flaps were unilateral and based on the transverse cervical artery in every patient. Indication for flap closure included inability to perform primary layered closure (N=3), open wound with infection (N=2), and exposed hardware (N=1). All patients had previous operations of the cervicothoracic spine (mean, 5.8 months; range 2-9 months) for malignant disease and prior radiation therapy. Exposed dura was present in all patients, and 2 patients had dural repairs with bovine pericardial patches. Spinal stabilization hardware was present in 4 patients. All patients underwent perioperative treatment with systemic corticosteroids. All flaps survived, and primary wound healing was achieved in each patient. The only wound complication was a malignant pleural effusion communicating with the back wound, which was controlled with a closed suction drain. All wounds remained healed during the follow-up period. Four patients died from progression of disease within 10 months of surgery. The trapezius turnover flap has been used successfully when local tissue conditions prevent primary closure, or in the setting of open, infected wounds with exposed dura and hardware. The ease of flap elevation and minimal donor site morbidity make it a useful, single-stage reconstructive option in these difficult wounds.
Keywords: adult; clinical article; treatment outcome; aged; middle aged; cancer surgery; surgical technique; retrospective studies; surgical flaps; wound healing; spinal cord compression; decompression, surgical; reoperation; pleura effusion; corticosteroid; free tissue graft; wound closure; drainage; skin transplantation; muscle, skeletal; surgical wound infection; thoracic spine; spinal cord neoplasms; cervical spine; spine cancer; trapezius muscle; humans; human; male; female; priority journal; article
Journal Title: Annals of Plastic Surgery
Volume: 47
Issue: 4
ISSN: 0148-7043
Publisher: Lippincott Williams & Wilkins  
Date Published: 2001-10-01
Start Page: 394
End Page: 397
Language: English
PUBMED: 11601574
PROVIDER: scopus
Notes: Export Date: 21 May 2015 -- Source: Scopus
Citation Impact
MSK Authors
  1. Joseph Disa
    223 Disa
  2. Andrew W Smith
    2 Smith
  3. Mark H Bilsky
    263 Bilsky