{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T07:10:52Z","timestamp":1771485052156,"version":"3.50.1"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2014,12]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Wound-related complications following complex posterior spine procedures in children may result in the need for serial debridements and may place spinal instrumentation at risk. In this study, the authors review their experience with the management of soft-tissue defects from spinal instrumentation in 5 high-risk pediatric patients. The use of various rotational and transpositional flaps in the management of these complicated cases is discussed, as well as their outcomes.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The authors retrospectively reviewed the medical records of 5 patients who returned to the Neuro-Spine service at Texas Children's Hospital for erosion of spinal instrumentation through the skin between September 1, 2007, and October 31, 2012. Patient demographics and clinical and operative data were recorded.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Risk factors such as young age (1 case), poor nutritional status (1 case), multiple previous surgeries (3 cases), severe neurological deficits (2 cases), and history of radiation therapy for malignancy (2 cases) were noted in the 5 patients. The paraspinous flap (4 cases) was the mainstay of the treatment. Follow-up ranged from 7.5 to 17.5 months (mean 11 \u00b1 4.2 months). One of the patients required more than 1 procedure for revision of the wound. Cultures were positive in 2 of the 5 cases. Spinal instrumentation was removed in 3 of the 5 cases; however, in all 3 of the cases there was evidence of delayed instability that developed after the removal of spinal instrumentation.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The use of local tissue flaps is safe and efficacious for treatment of posterior wound complications due to spinal instrumentation in children. Removal of spinal instrumentation should be avoided due to the development of delayed instability. Highly vascularized tissue is used to speed healing, clear bacteria, and eliminate dead space, obviating the need to remove contaminated spinal instrumentation.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.8.peds13664","type":"journal-article","created":{"date-parts":[[2014,9,26]],"date-time":"2014-09-26T15:20:39Z","timestamp":1411744839000},"page":"644-653","source":"Crossref","is-referenced-by-count":4,"title":["Soft-tissue defects after spinal instrumentation in 5 children: risk factors, management strategies, and outcomes"],"prefix":"10.3171","volume":"14","author":[{"given":"Christina","family":"Sayama","sequence":"first","affiliation":[{"name":"Neuro-Spine Program, Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sudhakar","family":"Vadivelu","sequence":"additional","affiliation":[{"name":"Neuro-Spine Program, Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine;"},{"name":"Cincinnati Children's Hospital, Division of Pediatric Neurosurgery, Cincinnati, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Livingston","sequence":"additional","affiliation":[{"name":"Neuro-Spine Program, Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine;"},{"name":"The Methodist Hospital Department of Neurosurgery, Houston, Texas; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allen","family":"Ho","sequence":"additional","affiliation":[{"name":"Neuro-Spine Program, Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shayan A.","family":"Izaddoost","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Baylor College of Medicine;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valentina","family":"Brice\u00f1o","sequence":"additional","affiliation":[{"name":"Neuro-Spine Program, Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas G.","family":"Luerssen","sequence":"additional","affiliation":[{"name":"Neuro-Spine Program, Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Jea","sequence":"additional","affiliation":[{"name":"Neuro-Spine Program, Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-peds13664","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2193","DOI":"10.1097\/BRS.0b013e3181f070b5","article-title":"Complications of growth-sparing surgery in early onset scoliosis","volume":"35","author":"Akbarnia","year":"2010"},{"key":"b2-peds13664","series-title":"Schmidek and Sweet: Operative Neurosurgical Techniques","first-page":"759","article-title":"Instrumentation and stabilization of the pediatric spine: technical nuances and age-specific considerations","author":"Chern","year":"2012"},{"key":"b3-peds13664","series-title":"Ann Plast Surg","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1097\/01.SAP.0000063754.39566.5C","article-title":"Reconstruction after extirpation of sacral malignancies","volume":"51","author":"Diaz","year":"2003"},{"key":"b4-peds13664","series-title":"Ann Plast Surg","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1097\/00000637-200110000-00006","article-title":"Management of radiated reoperative wounds of the cervicothoracic spine: the role of the trapezius turnover flap","volume":"47","author":"Disa","year":"2001"},{"key":"b5-peds13664","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1097\/00006534-199009000-00026","article-title":"Comparison of the intracellular bacterial killing activity of leukocytes in musculocutaneous and random-pattern flaps","volume":"86","author":"Eshima","year":"1990"},{"key":"b6-peds13664","series-title":"Microsurgery","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1002\/(SICI)1098-2752(1996)17:8<449::AID-MICR6>3.0.CO;2-9","article-title":"Latissimus dorsi free flap for sacral wound closure: the world's longest vein grafts for free tissue transfer","volume":"17","author":"Fudem","year":"1996"},{"key":"b7-peds13664","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.1097\/00006534-200003000-00026","article-title":"Gluteus maximus adipomuscular turnover or sliding flap in the surgical treatment of extensive sacral chordomas","volume":"105","author":"Furukawa","year":"2000"},{"key":"b8-peds13664","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1097\/00007632-200104010-00025","article-title":"Spinal radiation before surgical decompression adversely affects outcomes of surgery for symptomatic metastatic spinal cord compression","volume":"26","author":"Ghogawala","year":"2001"},{"key":"b9-peds13664","series-title":"Arch Surg","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1001\/archsurg.134.1.36","article-title":"Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study","volume":"134","author":"Gibbs","year":"1999"},{"key":"b10-peds13664","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2163","DOI":"10.1097\/00007632-199609150-00021","article-title":"Salvage of instrumental lumbar fusions complicated by surgical wound infection","volume":"21","author":"Glassman","year":"1996"},{"key":"b11-peds13664","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1097\/00006534-199808000-00013","article-title":"Muscle and musculocutaneous flap coverage of exposed spinal fusion devices","volume":"102","author":"Hochberg","year":"1998"},{"key":"b12-peds13664","series-title":"Ann Plast Surg","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1097\/00000637-199805000-00002","article-title":"Paraspinous muscle flaps","volume":"40","author":"Manstein","year":"1998"},{"key":"b13-peds13664","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1097\/00006534-197808000-00007","article-title":"Repair of major defects of the chest wall and spine with the latissimus dorsi myocutaneous flap","volume":"62","author":"McCraw","year":"1978"},{"key":"b14-peds13664","series-title":"Arch Phys Med Rehabil","doi-asserted-by":"publisher","first-page":"1402","DOI":"10.1016\/S0003-9993(99)90251-4","article-title":"Long-term medical complications after traumatic spinal cord injury: a regional model systems analysis","volume":"80","author":"McKinley","year":"1999"},{"key":"b15-peds13664","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1097\/00007632-199803150-00015","article-title":"Factors influencing wound healing after surgery for metastatic disease of the spine","volume":"23","author":"McPhee","year":"1998"},{"key":"b16-peds13664","series-title":"J Pediatr Surg","doi-asserted-by":"publisher","first-page":"1154","DOI":"10.1016\/S0022-3468(97)90673-4","article-title":"Latissimus dorsi flap procedures to cover myelomeningocele in utero: a feasibility study in human fetuses","volume":"32","author":"Meuli-Simmen","year":"1997"},{"key":"b17-peds13664","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1097\/01.PRS.0000097440.15013.5C","article-title":"Treatment of massive thoracolumbar wounds and vertebral osteomyelitis following scoliosis surgery","volume":"113","author":"Mitra","year":"2004"},{"key":"b18-peds13664","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"524","DOI":"10.2106\/00004623-199504000-00004","article-title":"Delayed infections following posterior spinal instrumentation for the treatment of idiopathic scoliosis","volume":"77","author":"Richards","year":"1995"},{"key":"b19-peds13664","series-title":"Orthop Clin North Am","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1016\/S0030-5898(20)32058-7","article-title":"Wound management in spinal infection","volume":"27","author":"Rubayi","year":"1996"},{"key":"b20-peds13664","series-title":"Anesthesiology","doi-asserted-by":"publisher","first-page":"670","DOI":"10.1097\/00000542-199205000-00002","article-title":"Thermoregulatory vasoconstriction during isoflurane anesthesia minimally decreases cutaneous heat loss","volume":"76","author":"Sessler","year":"1992"},{"key":"b21-peds13664","series-title":"J Bone Joint Surg Br","first-page":"8","article-title":"The management of complex soft-tissue defects after spinal instrumentation","volume":"88","author":"Singh","year":"2006"},{"key":"b22-peds13664","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1097\/00006534-199005000-00015","article-title":"Extensive wounds of the spine: a comprehensive approach to debridement and reconstruction","volume":"85","author":"Stahl","year":"1990"},{"key":"b23-peds13664","series-title":"J Hosp Infect","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1016\/0195-6701(87)90006-5","article-title":"Methicillin resistant Staphylococcus aureus; the role of antisepsis in the control of an outbreak","volume":"10","author":"Tuffnell","year":"1987"},{"issue":"1 Suppl Spine","key":"b24-peds13664","series-title":"J Neurosurg","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","year":"2004"},{"key":"b25-peds13664","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1097\/00006534-200011000-00011","article-title":"Bipedicle paraspinous muscle flaps for spinal wound closure: an anatomic and clinical study","volume":"106","author":"Wilhelmi","year":"2000"},{"issue":"2","key":"b26-peds13664","series-title":"Neurosurg Focus","first-page":"E5","article-title":"Surgical techniques for total sacrectomy and spinopelvic reconstruction","volume":"15","author":"Zhang","year":"2003"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/14\/6\/article-p644.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/14\/6\/article-p644.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/14\/6\/article-p644.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T16:04:07Z","timestamp":1681574647000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/14\/6\/article-p644.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2014,12]]},"references-count":26,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2014.8.peds13664","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,12]]}}}