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Reconstruction of Lumbar Spinal Defects: Case Series, Literature Review, and Treatment Algorithm

Lumbar spinal defects present a distinct challenge for the reconstructive surgeon and are often complicated by previous spinal surgery, the presence of hardware, and prior radiation. There are a variety of reconstructive options described but no clear treatment algorithm for these challenging defect...

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Autores principales: Daly, Lauren T., Amador, Ricardo O., Shin, John H., Bojovic, Branko, Eberlin, Kyle R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382243/
https://www.ncbi.nlm.nih.gov/pubmed/30859046
http://dx.doi.org/10.1097/GOX.0000000000002089
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author Daly, Lauren T.
Amador, Ricardo O.
Shin, John H.
Bojovic, Branko
Eberlin, Kyle R.
author_facet Daly, Lauren T.
Amador, Ricardo O.
Shin, John H.
Bojovic, Branko
Eberlin, Kyle R.
author_sort Daly, Lauren T.
collection PubMed
description Lumbar spinal defects present a distinct challenge for the reconstructive surgeon and are often complicated by previous spinal surgery, the presence of hardware, and prior radiation. There are a variety of reconstructive options described but no clear treatment algorithm for these challenging defects. METHODS: A literature search was performed to review the described treatment options for lumbar spinal soft-tissue defects. Treatments for myelomeningocele or pressure ulcers were excluded. In addition, a retrospective case review was performed for patients with lumbar defects treated with pedicled superior gluteal artery perforator (SGAP) flap reconstruction. RESULTS: A literature review revealed 2,022 articles pertaining to lumbar defect reconstruction, of which 56 met inclusion criteria. These articles described 13 individual reconstructive techniques for this anatomic area. The most commonly described techniques were evaluated and a treatment algorithm designed based on patient and wound characteristics. The clinical course of 5 patients with radiated lumbar spinal defects treated with SGAP flaps is presented. CONCLUSIONS: There are many treatment options for lumbar spinal defects and treatment should be tailored to the patient and the characteristics of the defect. For large or radiated lumbar wounds, the pedicled SGAP flap is an excellent reconstructive choice, as it has reliable anatomy that is outside the zone of injury, adequate bulk, and minimal donor-site deficits.
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spelling pubmed-63822432019-03-11 Reconstruction of Lumbar Spinal Defects: Case Series, Literature Review, and Treatment Algorithm Daly, Lauren T. Amador, Ricardo O. Shin, John H. Bojovic, Branko Eberlin, Kyle R. Plast Reconstr Surg Glob Open Original Article Lumbar spinal defects present a distinct challenge for the reconstructive surgeon and are often complicated by previous spinal surgery, the presence of hardware, and prior radiation. There are a variety of reconstructive options described but no clear treatment algorithm for these challenging defects. METHODS: A literature search was performed to review the described treatment options for lumbar spinal soft-tissue defects. Treatments for myelomeningocele or pressure ulcers were excluded. In addition, a retrospective case review was performed for patients with lumbar defects treated with pedicled superior gluteal artery perforator (SGAP) flap reconstruction. RESULTS: A literature review revealed 2,022 articles pertaining to lumbar defect reconstruction, of which 56 met inclusion criteria. These articles described 13 individual reconstructive techniques for this anatomic area. The most commonly described techniques were evaluated and a treatment algorithm designed based on patient and wound characteristics. The clinical course of 5 patients with radiated lumbar spinal defects treated with SGAP flaps is presented. CONCLUSIONS: There are many treatment options for lumbar spinal defects and treatment should be tailored to the patient and the characteristics of the defect. For large or radiated lumbar wounds, the pedicled SGAP flap is an excellent reconstructive choice, as it has reliable anatomy that is outside the zone of injury, adequate bulk, and minimal donor-site deficits. Wolters Kluwer Health 2019-01-11 /pmc/articles/PMC6382243/ /pubmed/30859046 http://dx.doi.org/10.1097/GOX.0000000000002089 Text en Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Original Article
Daly, Lauren T.
Amador, Ricardo O.
Shin, John H.
Bojovic, Branko
Eberlin, Kyle R.
Reconstruction of Lumbar Spinal Defects: Case Series, Literature Review, and Treatment Algorithm
title Reconstruction of Lumbar Spinal Defects: Case Series, Literature Review, and Treatment Algorithm
title_full Reconstruction of Lumbar Spinal Defects: Case Series, Literature Review, and Treatment Algorithm
title_fullStr Reconstruction of Lumbar Spinal Defects: Case Series, Literature Review, and Treatment Algorithm
title_full_unstemmed Reconstruction of Lumbar Spinal Defects: Case Series, Literature Review, and Treatment Algorithm
title_short Reconstruction of Lumbar Spinal Defects: Case Series, Literature Review, and Treatment Algorithm
title_sort reconstruction of lumbar spinal defects: case series, literature review, and treatment algorithm
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382243/
https://www.ncbi.nlm.nih.gov/pubmed/30859046
http://dx.doi.org/10.1097/GOX.0000000000002089
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