The role of the plastic surgeon in wound repair after spinal surgery

BACKGROUND: Wound complications, including dehiscence and surgical site infections, following spinal surgery have the potential to be devastating both to the patient and to the hospital system. Complications can occur in a wide range of patients including diabetics, those of low or high BMI and those of old age. Obese patients and those with increased subcutaneous fat are at particularly high risk for wound complications, which may be mitigated through use of local flap reconstruction by a Plastic Surgeon. CASE DESCRIPTION: A 28 year-old female with morbid obesity presents with multiple lumbar transverse process fractures and complex sacral and pelvic fractures requiring closed reduction and percutaneous fixation of the pelvic ring followed by posterior spinal fusion. The patient was closed tension-free by the neurosurgery team and ultimately dehisced requiring consultation and management by Plastic Surgery. OUTCOME: The patient underwent debridement and reconstruction with a gluteus maximus myocutaneous flap advancement without complication. CONCLUSIONS: Wound management after spinal surgery is a complex problem, which may be prophylaxed through early identification of high-risk patients and preoperative consultation of Plastic Surgery. Patients with increased thickness of subcutaneous fat are at particularly high risk for postoperative complications, including infection and dehiscence, secondary to increased tissue manipulation and necrosis.