{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T04:11:26Z","timestamp":1791432686801,"version":"4.3.3"},"reference-count":59,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":25,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Reconstructing spinal defects complicated by surgical site infection (SSI) is challenging, with SSIs occurring in 1%\u20134% of spine surgeries, often involving hardware exposure. These infections increase hospital stays, costs, and risks of poor outcomes. Effective management strategies are crucial for addressing infected spinal wounds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic review following PRISMA\u2010P guidelines across six databases. Included studies reported flap coverage for spinal reconstructions with or without hardware. Outcomes of interest included flap loss, partial flap necrosis, wound dehiscence, venous thrombosis, and infection rates. Quality was evaluated using ASPS criteria and the ROBINS\u2010I tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Out of 4436 articles, 32 studies were included, comprising 969 patients, with 496 undergoing reconstructions for infected chronic wounds. The mean patient age was 52.1\u2009years. Infection contributors included spinal instrumentation, radiotherapy, smoking, and diabetes, with\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      <\/jats:styled-content>\n                      being the most common organism (52.7%). Paraspinal muscle flaps and latissimus dorsi flaps were most frequently used. Out of the 27 studies that investigated the need for hardware removal, eight reported patients required it in the postoperative period. The pooled flap survival rate was 89%, with muscle flaps showing higher effectiveness compared to fasciocutaneous flaps (92% vs. 85%). Other complications included wound dehiscence (12%), flap necrosis (8%), and reinfection (10%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study provides evidence\u2010based insights into managing complex spinal defects. Flap reconstruction remains a viable solution for soft\u2010tissue coverage, highlighting the importance of tailored surgical planning based on defect characteristics and patient factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/micr.70216","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T14:07:27Z","timestamp":1774534047000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Flap Use for Wound Coverage After Spinal Hardware Infection: A Systematic Review of the Literature"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7043-2210","authenticated-orcid":false,"given":"Marah I.","family":"Jolibois","sequence":"first","affiliation":[{"name":"Division of Plastic and Maxillofacial Surgery Children's Hospital Los Angeles  Los Angeles California USA"},{"name":"Albany Medical College  Albany New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Artur","family":"Manasyan","sequence":"additional","affiliation":[{"name":"Keck School of Medicine University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Idean","family":"Roohani","sequence":"additional","affiliation":[{"name":"Keck School of Medicine University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Williams","sequence":"additional","affiliation":[{"name":"Keck School of Medicine University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph N.","family":"Carey","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3958-8441","authenticated-orcid":false,"given":"David A.","family":"Daar","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/2192568218819817"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2019.206"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12967-024-04882-9"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-198984040-00013"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000261555.72265.3f"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199609010-00018"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.3171\/2015.7.FOCUS15245"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1590\/S1807-59322008000200019"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000029366"},{"issue":"6","key":"e_1_2_9_11_1","first-page":"921","article-title":"An Improved Method of Supercharged Transposed Latissimus Dorsi Flap With the Skin Paddle for the Management of a Complicated Lumbosacral Defect","volume":"19","author":"Cigna E.","year":"2015","journal-title":"European Review for Medical and Pharmacological Sciences"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000001875"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000002089"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000001249"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2007.05.005"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000001048"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000003679"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200205000-00028"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.21873\/invivo.11546"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.BRS.0000067260.22943.48"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2018.05.022"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199703010-00021"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199412000-00023"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199406000-00030"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199610150-00018"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.5312\/wjo.v3.i11.182"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199808000-00013"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sap.0000226931.23076.a7"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000003341"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.7150\/jbji.23832"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.4103\/ajns.AJNS_129_19"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000013851"},{"issue":"5","key":"e_1_2_9_33_1","first-page":"S392","article-title":"Infection With Spinal Instrumentation: Review of Pathogenesis, Diagnosis, Prevention, and Management","volume":"4","author":"Kasliwal M. K.","year":"2013","journal-title":"Surgical Neurology International"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000002821"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2018.e01067"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199407000-00008"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-006-0164-2"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000002076"},{"key":"e_1_2_9_39_1","first-page":"e50","article-title":"Technical Changes in Paraspinous Muscle Flap Surgery Have Increased Salvage Rates of Infected Spinal Wounds","volume":"8","author":"Mericli A. F.","year":"2008","journal-title":"Eplasty"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0b013e3181c47ef4"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.PRS.0000097440.15013.5C"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31815cffe2"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2016.186"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181b616eb"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2017.06.011"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sap.0000178805.90185.59"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1227\/00006123-199408000-00019"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1445-2197.2003.02748.x"},{"key":"e_1_2_9_49_1","doi-asserted-by":"publisher","DOI":"10.1177\/2192568217752130"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199005000-00015"},{"issue":"3","key":"e_1_2_9_51_1","first-page":"401","article-title":"The Use of Muscle Flaps in the Salvage of Infected Exposed Implants for Internal Fixation","volume":"92","author":"Tan K. J.","year":"2010","journal-title":"Journal of Bone and Joint Surgery. British Volume"},{"key":"e_1_2_9_52_1","doi-asserted-by":"publisher","DOI":"10.4103\/0970-0358.96617"},{"key":"e_1_2_9_53_1","doi-asserted-by":"publisher","DOI":"10.3390\/jpm12071130"},{"key":"e_1_2_9_54_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e31819f2b5e"},{"key":"e_1_2_9_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcot.2022.101984"},{"issue":"1","key":"e_1_2_9_56_1","first-page":"46","article-title":"Rotational and Transpositional Flaps for the Treatment of Spinal Wound Dehiscence and Infections in Patient Populations With Degenerative and Oncological Disease","volume":"100","author":"Vitaz T. W.","year":"2004","journal-title":"Journal of Neurosurgery"},{"key":"e_1_2_9_57_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199804010-00012"},{"key":"e_1_2_9_58_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200011000-00011"},{"key":"e_1_2_9_59_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002517-199612000-00008"},{"key":"e_1_2_9_60_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200102010-00006"}],"container-title":["Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.70216","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/micr.70216","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.70216","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T10:58:42Z","timestamp":1775991522000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/micr.70216"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":59,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1002\/micr.70216"],"URL":"https:\/\/doi.org\/10.1002\/micr.70216","archive":["Portico"],"relation":{},"ISSN":["0738-1085","1098-2752"],"issn-type":[{"value":"0738-1085","type":"print"},{"value":"1098-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"assertion":[{"value":"2024-09-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70216"}}