{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T05:38:52Z","timestamp":1781588332407,"version":"3.54.5"},"reference-count":66,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2015,10]]},"abstract":"\n OBJECT<\/jats:title>\n A systematic review of the available evidence on the prophylactic and therapeutic use of flaps for the coverage of complex spinal soft-tissue defects was performed to determine if the use of flaps reduces postoperative complications and improves patient outcomes.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n A PubMed database search was performed to identify English-language articles published between 1990 and 2014 that contained the following phrases to describe postoperative wounds (\u201cwound,\u201d \u201ccomplex back wound,\u201d \u201cpostoperative wound,\u201d \u201cspine surgery\u201d) and intervention (\u201cflap closure,\u201d \u201cflap coverage,\u201d \u201csoft tissue reconstruction,\u201d \u201cmuscle flap\u201d).<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n In total, 532 articles were reviewed with 17 articles meeting the inclusion criteria of this study. The risk factors from the pooled analysis of 262 patients for the development of postoperative complex back wounds that necessitated muscle flap coverage included the involvement of instrumentation (77.6%), a previous history of radiotherapy (33.2%), smoking (20.6%), and diabetes mellitus (17.2%). In patients with instrumentation, prophylactic coverage of the wound with a well-vascularized flap was shown to result in a lower incidence of wound complications. One study showed a statistically significant decrease in complications compared with patients where prophylactic coverage was not performed (20% vs 45%). The indications for flap coverage after onset of wound complications included hardware exposure, wound infection, dehiscence, seroma, and hematoma. Flap coverage was shown to decrease the number of surgical debridements needed and also salvage hardware, with the rate of hardware removal after flap coverage ranging from 0% to 41.9% in 4 studies.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Prophylactic coverage with flaps in high-risk patients undergoing spine surgery reduces complications, while therapeutic coverage following wound complications allows the salvage of hardware in the majority of patients.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2015.7.focus15245","type":"journal-article","created":{"date-parts":[[2015,10,1]],"date-time":"2015-10-01T03:41:45Z","timestamp":1443670905000},"page":"E17","source":"Crossref","is-referenced-by-count":57,"title":["Reconstruction of open wounds as a complication of spinal surgery with flaps: a systematic review"],"prefix":"10.3171","volume":"39","author":[{"given":"Lee Onn","family":"Chieng","sequence":"first","affiliation":[{"name":"University of Miami Miller School of Medicine; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Hubbard","sequence":"additional","affiliation":[{"name":"University of Miami Miller School of Medicine; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Salgado","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan D.","family":"Levi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harvey","family":"Chim","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus15245","series-title":"Spine J","first-page":"2911","article-title":"Negative pressure wound therapy reduces incidence of postoperative wound infection and dehiscence after long-segment thoracolumbar spinal fusion: a single institutional experience","volume":"14","author":"Adogwa","year":"2014"},{"key":"b2-focus15245","series-title":"Int Wound J","first-page":"103","article-title":"The operative treatment of pressure wounds: a 10-year experience in flap selection","volume":"7","author":"Ahluwalia","year":"2010"},{"key":"b3-focus15245","series-title":"Plast Reconstr Surg","first-page":"635e","article-title":"Lumbar and thoracic perforators: vascular anatomy and clinical implications","volume":"134","author":"Aho","year":"2014"},{"key":"b4-focus15245","series-title":"Eur J Plast Surg","first-page":"202","article-title":"Immediate debridement and coverage of exposed spinal hardware with muscle flaps","volume":"25","author":"Aky\u00fcrek","year":"2002"},{"key":"b5-focus15245","series-title":"Plast Reconstr Surg","first-page":"785","article-title":"Comparison of the effect of bacterial inoculation in musculocutaneous and fasciocutaneous flaps","volume":"77","author":"Calderon","year":"1986"},{"key":"b6-focus15245","series-title":"Orthop Clin North Am","first-page":"83","article-title":"Perioperative risk factors for wound infections after lower back fusions","volume":"27","author":"Capen","year":"1996"},{"key":"b7-focus15245","series-title":"Spine (Phila Pa 1976)","first-page":"1101","article-title":"Reconstructive strategies in soft tissue reconstruction after resection of spinal neoplasms","volume":"32","author":"Chang","year":"2007"},{"key":"b8-focus15245","series-title":"Spine (Phila Pa 1976)","first-page":"2016","article-title":"Chronic osteomyelitis of the spine managed with a free flap of latissimus dorsi. A case report","volume":"21","author":"Chen","year":"1996"},{"key":"b9-focus15245","series-title":"Ann Plast Surg","first-page":"17","article-title":"Distal trapezius musculocutaneous flap for upper thoracic back wounds associated with spinal instrumentation and radiation","volume":"51","author":"Chun","year":"2003"},{"key":"b10-focus15245","series-title":"Spine (Phila Pa 1976)","first-page":"1203","article-title":"Muscle flap salvage of spine wounds with soft tissue defects or infection","volume":"28","author":"Dumanian","year":"2003"},{"key":"b11-focus15245","series-title":"Plast Reconstr Surg","first-page":"541","article-title":"Comparison of the intracellular bacterial killing activity of leukocytes in musculocutaneous and random-pattern flaps","volume":"86","author":"Eshima","year":"1990"},{"key":"b12-focus15245","series-title":"Br J Plast Surg","first-page":"374","article-title":"Ischial pressure sore coverage: a rationale for flap selection","volume":"50","author":"Foster","year":"1997"},{"key":"b13-focus15245","series-title":"Plast Reconstr Surg","first-page":"1460","article-title":"Immediate soft-tissue reconstruction for complex defects of the spine following surgery for spinal neoplasms","volume":"125","author":"Garvey","year":"2010"},{"key":"b14-focus15245","series-title":"Plast Reconstr Surg","first-page":"1060","article-title":"Supercharged latissimus dorsi muscle flap for coverage of the problem wound in the lower back","volume":"94","author":"Giesswein","year":"1994"},{"key":"b15-focus15245","series-title":"Spine (Phila Pa 1976)","first-page":"2163","article-title":"Salvage of instrumental lumbar fusions complicated by surgical wound infection","volume":"21","author":"Glassman","year":"1996"},{"key":"b16-focus15245","series-title":"Plast Reconstr Surg","first-page":"385","article-title":"Muscle and musculocutaneous flap coverage of exposed spinal fusion devices","volume":"102","author":"Hochberg","year":"1998"},{"key":"b17-focus15245","series-title":"Ann Plast Surg","first-page":"521","article-title":"Salvage of infected spinal hardware with paraspinous muscle flaps: anatomic considerations with clinical correlation","volume":"57","author":"Hultman","year":"2006"},{"key":"b18-focus15245","series-title":"BMC Surg","first-page":"85","article-title":"Can hyperbaric oxygen be used to prevent deep infections in neuro-muscular scoliosis surgery?","volume":"14","author":"Inanmaz","year":"2014"},{"key":"b19-focus15245","series-title":"J Neurosurg Spine","first-page":"974","article-title":"A meta-analysis of spinal surgical site infection and vancomycin powder","volume":"21","author":"Khan","year":"2014"},{"key":"b20-focus15245","series-title":"Spine (Phila Pa 1976)","first-page":"1467","article-title":"Muscle flap closure for salvage of complex back wounds","volume":"19","author":"Klink","year":"1994"},{"key":"b21-focus15245","series-title":"J Bone Joint Surg Am","first-page":"1627","article-title":"Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis","volume":"93","author":"Koutsoumbelis","year":"2011"},{"key":"b22-focus15245","series-title":"Plast Reconstr Surg","first-page":"960","article-title":"Lower back coverage with endoscopically harvested pedicled greater omental flap","volume":"103","author":"Lantieri","year":"1999"},{"key":"b23-focus15245","series-title":"Neurosurgery","first-page":"287","article-title":"Hyperbaric oxygen treatment of postoperative neurosurgical infections","volume":"50","author":"Larsson","year":"2002"},{"key":"b24-focus15245","series-title":"Spine (Phila Pa 1976)","first-page":"1893","article-title":"Use of the reverse latissimus muscle flap for closure of complex back wounds in patients with spinal cord injury","volume":"28","author":"Meiners","year":"2003"},{"key":"b25-focus15245","series-title":"Ann Plast Surg","first-page":"219","article-title":"Paraspinous muscle flap reconstruction of complex midline back wounds: Risk factors and postreconstruction complications","volume":"65","author":"Mericli","year":"2010"},{"key":"b26-focus15245","series-title":"Plast Reconstr Surg","first-page":"206","article-title":"Treatment of massive thoracolumbar wounds and vertebral osteomyelitis following scoliosis surgery","volume":"113","author":"Mitra","year":"2004"},{"key":"b27-focus15245","series-title":"J Surg Res","first-page":"75","article-title":"The effect of microbial contamination on musculocutaneous and random flaps","volume":"41","author":"Murphy","year":"1986"},{"key":"b28-focus15245","series-title":"Spine (Phila Pa 1976)","first-page":"3074","article-title":"Pedicled omental flaps as an adjunct in the closure of complex spinal wounds","volume":"32","author":"O\u2019Shaughnessy","year":"2007"},{"key":"b29-focus15245","series-title":"Arch Phys Med Rehabil","first-page":"1556","article-title":"Surgical treatment of pressure ulcers: 20-year experience","volume":"81","author":"Schryvers","year":"2000"},{"key":"b30-focus15245","series-title":"Plast Reconstr Surg","first-page":"747","article-title":"Extensive wounds of the spine: a comprehensive approach to debridement and reconstruction","volume":"85","author":"Stahl","year":"1990"},{"key":"b31-focus15245","series-title":"Spine (Phila Pa 1976)","first-page":"981","article-title":"Postoperative infections in spinal implants. Classification and analysis\u2014a multicenter study","volume":"16","author":"Thalgott","year":"1991"},{"issue":"1 Suppl Spine","key":"b32-focus15245","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":"b33-focus15245","series-title":"Clin Neurol Neurosurg","first-page":"6","article-title":"Sinking skin flap syndrome and paradoxical herniation secondary to lumbar drainage","volume":"133","author":"Zhao","year":"2015"},{"key":"b1-focus15245","series-title":"Spine J","first-page":"2911","article-title":"Negative pressure wound therapy reduces incidence of postoperative wound infection and dehiscence after long-segment thoracolumbar spinal fusion: a single institutional experience","volume":"14","author":"Adogwa","year":"2014"},{"key":"b2-focus15245","series-title":"Int Wound J","first-page":"103","article-title":"The operative treatment of pressure wounds: a 10-year experience in flap selection","volume":"7","author":"Ahluwalia","year":"2010"},{"key":"b3-focus15245","series-title":"Plast Reconstr Surg","first-page":"635e","article-title":"Lumbar and thoracic perforators: vascular anatomy and clinical implications","volume":"134","author":"Aho","year":"2014"},{"key":"b4-focus15245","series-title":"Eur J Plast Surg","first-page":"202","article-title":"Immediate debridement and coverage of exposed spinal hardware with muscle flaps","volume":"25","author":"Aky\u00fcrek","year":"2002"},{"key":"b5-focus15245","series-title":"Plast Reconstr Surg","first-page":"785","article-title":"Comparison of the effect of bacterial inoculation in musculocutaneous and fasciocutaneous flaps","volume":"77","author":"Calderon","year":"1986"},{"key":"b6-focus15245","series-title":"Orthop Clin North Am","first-page":"83","article-title":"Perioperative risk factors for wound infections after lower back fusions","volume":"27","author":"Capen","year":"1996"},{"key":"b7-focus15245","series-title":"Spine (Phila Pa 1976)","first-page":"1101","article-title":"Reconstructive strategies in soft tissue reconstruction after resection of spinal neoplasms","volume":"32","author":"Chang","year":"2007"},{"key":"b8-focus15245","series-title":"Spine (Phila Pa 1976)","first-page":"2016","article-title":"Chronic osteomyelitis of the spine managed with a free flap of latissimus dorsi. A case report","volume":"21","author":"Chen","year":"1996"},{"key":"b9-focus15245","series-title":"Ann Plast Surg","first-page":"17","article-title":"Distal trapezius musculocutaneous flap for upper thoracic back wounds associated with spinal instrumentation and radiation","volume":"51","author":"Chun","year":"2003"},{"key":"b10-focus15245","series-title":"Spine (Phila Pa 1976)","first-page":"1203","article-title":"Muscle flap salvage of spine wounds with soft tissue defects or infection","volume":"28","author":"Dumanian","year":"2003"},{"key":"b11-focus15245","series-title":"Plast Reconstr Surg","first-page":"541","article-title":"Comparison of the intracellular bacterial killing activity of leukocytes in musculocutaneous and random-pattern flaps","volume":"86","author":"Eshima","year":"1990"},{"key":"b12-focus15245","series-title":"Br J Plast Surg","first-page":"374","article-title":"Ischial pressure sore coverage: a rationale for flap selection","volume":"50","author":"Foster","year":"1997"},{"key":"b13-focus15245","series-title":"Plast Reconstr Surg","first-page":"1460","article-title":"Immediate soft-tissue reconstruction for complex defects of the spine following surgery for spinal neoplasms","volume":"125","author":"Garvey","year":"2010"},{"key":"b14-focus15245","series-title":"Plast Reconstr Surg","first-page":"1060","article-title":"Supercharged latissimus dorsi muscle flap for coverage of the problem wound in the lower back","volume":"94","author":"Giesswein","year":"1994"},{"key":"b15-focus15245","series-title":"Spine (Phila Pa 1976)","first-page":"2163","article-title":"Salvage of instrumental lumbar fusions complicated by surgical wound infection","volume":"21","author":"Glassman","year":"1996"},{"key":"b16-focus15245","series-title":"Plast Reconstr Surg","first-page":"385","article-title":"Muscle and musculocutaneous flap coverage of exposed spinal fusion devices","volume":"102","author":"Hochberg","year":"1998"},{"key":"b17-focus15245","series-title":"Ann Plast Surg","first-page":"521","article-title":"Salvage of infected spinal hardware with paraspinous muscle flaps: anatomic considerations with clinical correlation","volume":"57","author":"Hultman","year":"2006"},{"key":"b18-focus15245","series-title":"BMC Surg","first-page":"85","article-title":"Can hyperbaric oxygen be used to prevent deep infections in neuro-muscular scoliosis surgery?","volume":"14","author":"Inanmaz","year":"2014"},{"key":"b19-focus15245","series-title":"J Neurosurg Spine","first-page":"974","article-title":"A meta-analysis of spinal surgical site infection and vancomycin powder","volume":"21","author":"Khan","year":"2014"},{"key":"b20-focus15245","series-title":"Spine (Phila Pa 1976)","first-page":"1467","article-title":"Muscle flap closure for salvage of complex back wounds","volume":"19","author":"Klink","year":"1994"},{"key":"b21-focus15245","series-title":"J Bone Joint Surg Am","first-page":"1627","article-title":"Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis","volume":"93","author":"Koutsoumbelis","year":"2011"},{"key":"b22-focus15245","series-title":"Plast Reconstr Surg","first-page":"960","article-title":"Lower back coverage with endoscopically harvested pedicled greater omental flap","volume":"103","author":"Lantieri","year":"1999"},{"key":"b23-focus15245","series-title":"Neurosurgery","first-page":"287","article-title":"Hyperbaric oxygen treatment of postoperative neurosurgical infections","volume":"50","author":"Larsson","year":"2002"},{"key":"b24-focus15245","series-title":"Spine (Phila Pa 1976)","first-page":"1893","article-title":"Use of the reverse latissimus muscle flap for closure of complex back wounds in patients with spinal cord injury","volume":"28","author":"Meiners","year":"2003"},{"key":"b25-focus15245","series-title":"Ann Plast Surg","first-page":"219","article-title":"Paraspinous muscle flap reconstruction of complex midline back wounds: Risk factors and postreconstruction complications","volume":"65","author":"Mericli","year":"2010"},{"key":"b26-focus15245","series-title":"Plast Reconstr Surg","first-page":"206","article-title":"Treatment of massive thoracolumbar wounds and vertebral osteomyelitis following scoliosis surgery","volume":"113","author":"Mitra","year":"2004"},{"key":"b27-focus15245","series-title":"J Surg Res","first-page":"75","article-title":"The effect of microbial contamination on musculocutaneous and random flaps","volume":"41","author":"Murphy","year":"1986"},{"key":"b28-focus15245","series-title":"Spine (Phila Pa 1976)","first-page":"3074","article-title":"Pedicled omental flaps as an adjunct in the closure of complex spinal wounds","volume":"32","author":"O\u2019Shaughnessy","year":"2007"},{"key":"b29-focus15245","series-title":"Arch Phys Med Rehabil","first-page":"1556","article-title":"Surgical treatment of pressure ulcers: 20-year experience","volume":"81","author":"Schryvers","year":"2000"},{"key":"b30-focus15245","series-title":"Plast Reconstr Surg","first-page":"747","article-title":"Extensive wounds of the spine: a comprehensive approach to debridement and reconstruction","volume":"85","author":"Stahl","year":"1990"},{"key":"b31-focus15245","series-title":"Spine (Phila Pa 1976)","first-page":"981","article-title":"Postoperative infections in spinal implants. Classification and analysis\u2014a multicenter study","volume":"16","author":"Thalgott","year":"1991"},{"issue":"1 Suppl Spine","key":"b32-focus15245","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":"b33-focus15245","series-title":"Clin Neurol Neurosurg","first-page":"6","article-title":"Sinking skin flap syndrome and paradoxical herniation secondary to lumbar drainage","volume":"133","author":"Zhao","year":"2015"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/39\/4\/article-pE17.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/39\/4\/article-pE17.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/39\/4\/article-pE17.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T08:23:44Z","timestamp":1775895824000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/39\/4\/article-pE17.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,10]]},"references-count":66,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2015.7.focus15245","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,10]]}}}