The Treatment of Posterior Wound Complication with Myocutaneous Flaps in Cancer Patients

Introduction: Poor wound healing and infection are major sources of morbidity in patients undergoing a posterior approach for decompression and instrumentation of malignant spinal tumors. Risk factors for wound associated complications in cancer patients include prior radiation (RT), steroids, multiple previous surgeries, and instrumentation. Prior treatment schemes including wound debridement and primary closure or wound packing have been unsatisfactory. We report our experience with musculocutaneous flap closure in cancer patients.

Methods: Of the 128 patients who underwent a posterior or posterolateral decompression and instrumentation of the spine for malignant tumor between Jan., l997 to Aug, l999, 10 patients (8%) were treated with musculocutaneous flap closure. Seven patients had trapezium based flaps and 3 patients had reverse latissimus dorsi flaps. Indications included wound dehiscence (4), infection (3), and prophylactic for multiple previous surgeries (3). All patients had received prior RT and high dose steroids. The mean number of previous surgeries was 5 (range 2 to 9).

Results: All patients healed their wounds, including those with active infection at the time of closure. One patient with a malignant effusion required a permanent drain. No patient required hardware removal. The only treatment related complication was a subcutaneous hematoma requiring evacuation. Five patients have died from progression of disease at a median of 7 months and the remaining 5 are alive 3 months to 2 years following treatment without wound complications.

Conclusion: Musculocutaneous flaps are a reliable and effective method to treat wound complications resulting from posterior spinal surgery for tumor. The trapezium, latissimus dorsi, and gluteus maximus can be used individually or in combination, as advancement flaps. The ease of elevation and minimal donor site morbidity make it an extremely useful single stage reconstructive option for these difficult wound problems.