UNASSIGNED: Nearly half a million interbody fusions are estimated to be performed in the US each year, many of which involve complex reconstruction. The ability to limit seroma formation is vital to a seamless postoperative recovery.
UNASSIGNED: A retrospective review was performed for patients undergoing fusion procedures along with flap reconstruction over a period of 20 months. Cohorts reflect a temporal practice shift where use of hydrolyzed collagen powder (HCP) was initiated for hypothesized seroma prevention. Outcomes and associated metrics were used for intergroup comparison.
UNASSIGNED: The study included 76 patients, of whom 47 were treated with HCP and 29 were not. Control patients had significantly fewer postoperative seromas than experimental ones (6.9% vs 27.7%; P = .03). The cohorts had no significant differences in time until final drain removal or in number of spinal levels involved (7.8 vs 7.1 days; P = .33, 8.5 vs 8.4 levels; P = .90). Rates of wound dehiscence, hematoma, or infection did not differ significantly between control and experimental patients (3.4% vs 12.8%, P = .17; 0% vs 0%; and 6.9% vs 10.6%, P = .58, respectively).
UNASSIGNED: The use of HCP led to a 4-fold increase in postoperative seromas in patients undergoing spinal fusion with flap reconstruction. This was regardless of all analyzed demographic and procedural factors, with the exception of age, whereby control patients were found to be on average slightly younger than experimental counterparts.

Large posterior trunk wounds often require flap reconstruction. One option for posterior truncal reconstruction not readily considered, often due to the combined anterior and posterior approaches required for harvesting and coverage, is the omental flap; however, the omental flap stands as a robust backup in non-healing wounds when local flap options have been exhausted. We present a case of a posterior trunk wound that had previously undergone multiple unsuccessful local and regional flaps for reconstruction and was ultimately treated with a pedicled omental flap which went on to heal without any post-operative complications.

BACKGROUND: Complex spine surgery in patients with major comorbidities leads to increased need for midline back wound reconstruction by plastic surgeons. Literature suggests that back wound reconstruction concurrent with high-risk immediate/index spine surgery may lead to fewer complication. This study aimed to validate this claim in a large cohort treated at a tertiary center. We hypothesize that immediate reconstruction may lead to fewer adverse events in comparison to delayed reconstruction.
METHODS: This was a retrospective single-center review of 659 patients who underwent spinal surgery with/without reconstruction by plastic surgeons between November 2011 and December 2015. Three main cohorts were evaluated: patients who underwent spinal surgery with no reconstruction, patients with delayed reconstruction after spine surgery, and patients with immediate back wound reconstruction with index spine surgery. Demographic, clinical, and outcomes data were collected from electronic medical records. Primary endpoints were the incidence of any complications such as dehiscence, infection, seroma/hematoma, and exposed hardware. The secondary endpoint was return to the operating room and most recent follow-up.
RESULTS: Forty-three patients underwent index reconstruction (follow-up 25.3 ± 12.7 months), 33 were delayed (follow-up 23.7 ± 12.5 months), and 583 had no reconstruction (follow-up 22.1 ± 15.2 months). Patients who underwent index reconstruction had more spinal levels involved than delayed reconstruction (7.8 ± 0.75 vs 5.6 ± 0.68; p = 0.03). The overall complications rate was 7.7%, most commonly wound dehiscence (2.7%), infections (0.9%), exposed hardware (2.0%), cerebrospinal fluid leaks (0.6%), and return to OR (3.8%). Patients who underwent index spinal wound reconstruction had a significantly lower complication rate (4.65%) than secondary spinal surgery patients (27.3%; p = 0.048).
CONCLUSIONS: The data confirmed significantly decreased complication rates for index back wound reconstructions for high-risk patients compared to delayed spine wound reconstruction. Increased rates of wound dehiscence, exposed hardware, and revisions occurred with delayed reconstruction. Early employment of tension free, robust vascular flap closure may attribute to a decreased complication profile.

BACKGROUND: Giant basal cell carcinomas are rare and potentially aggressive skin malignancies that are infrequently reported in the Literature, and they usually require aggressive surgical resection and immediate soft tissue reconstruction with skin grafts or flaps. The large size of GBCCs has relevant implications not only for the metastatic potential, but even for the reconstructive challenging due to the possible limited availability of tissues for flap coverage.
METHODS: We report the peculiar case of an old patient who underwent to GBCC resection of the back measuring 16 × 13 cm, and immediate reconstruction with a large O to Z flap harvested from the back; one-year follow-up examination revealed a satisfactory result and no recurrence of the disease was observed.
CONCLUSIONS: The review of the Literature showed that reconstructive options are mainly determined by the site and extent of the defect, exposed structures and patient characteristics and comorbidities, and previous series reported the use of skin grafts only, pedicled myocutaneous or perforator flaps, exclusively free flaps and a combination of techniques. Therefore, in this scenario local flaps such as O-Z flaps are less invasive procedures, that usually have lower rate of postoperative complications and shorter hospitalization compared to more complex procedures.
CONCLUSIONS: Despite the use of O-Z flap is quite unusual for back reconstruction, we believe that this flap represents a valid and safe alternative in selected cases, particularly in the elderly and medically compromised patients with multiple comorbidities.

BACKGROUND: The dorsal intercostal artery perforator (DICAP) flap is a well-vascularised flap that is elevated above the dorsal branch of the vertebral segments of the posterior intercostal artery. The aim of this study was to repair back defects using DICAP flaps.
METHODS: Eight patients who had undergone reconstruction with DICAP flaps for defects located on the back of the torso due to conditions of various aetiologies between 2011-2014 were included in this study. Patient age and gender, aetiology of the condition, dimensions of the defect and the flap, site of the defect, and postoperative complications were recorded.
RESULTS: Three females and five males were included in this study. The age of the patients ranged between 19-71 years (mean = 53.6 years). The aetiology was skin tumour in five patients and pressure wound, gunshot injury, and plate screw exposition subsequent to spinal surgery in one patient each. The sites of the defects were successfully closed in all patients, and no flap loss was observed in any patient.
CONCLUSIONS: DICAP flaps have some advantages compared to conventional muscle and muscle skin flaps, such as greater protection of muscle functions, less invasiveness, and lower donor site morbidity. This flap has a high mobilisation capacity due to its elevation above nine bilateral perforator arteries. Therefore, the DICAP flap is useful for the repair of median and paramedian back defects. Based on its advantages, it is suggested that the DICAP flap should be considered as a useful option for the repair of back defects.