Bipedicle paraspinous muscle flaps for spinal wound closure: An anatomic and clinical study

B. J. Wilhelmi, N. Snyder, T. Colquhoun, A. Hadjipavlou, Linda Phillips

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

The purpose of this study was to evaluate the vascular anatomy of the paraspinous muscles and review their clinical use as bipedicled flaps in spinal wound closure. Anatomically, through cadaver dissections, lead oxide injections, and radiographic imaging, the blood supply to the paraspinous muscles was determined. Clinically, 29 consecutive patients treated with spinal wounds and exposed bone or hardware were reviewed retrospectively. Of these patients, 19 underwent closure in delayed primary fashion, whereas 10 were referred to plastic surgery for reconstruction because of the complex nature of their wounds. The cadaver study demonstrated the paraspinous muscles to possess a segmental arterial supply through medial and lateral perforators. Division of the medial perforators allowed for medial advancement of the muscles. Lead oxide injection of the lateral perforators demonstrated adequate medial muscle perfusion with ligation of the medial perforators. Ten of the 29 patients (six women, four men, 32 to 62 years of age) were reconstructed with paraspinous (eight), latissimus (one), and trapezius (one) muscle flaps. A higher complication rate was found in wounds closed in delayed primary fashion (13 of 19 patients, 68 percent) than those reconstructed with muscle flaps (2 of 10 patients, 20 percent) (p = 0.021). Follow-up of the muscle flap reconstructed patients averaged 12 months (range, 3 to 27 months). Cadaver muscle injections predicted and clinical cases confirmed that the paraspinous muscles can be raised on lateral perforators and advanced medially to close lumbar spine wounds reliably with fewer complications.

Original languageEnglish (US)
Pages (from-to)1305-1311
Number of pages7
JournalPlastic and Reconstructive Surgery
Volume106
Issue number6
StatePublished - 2000

Fingerprint

Muscles
Wounds and Injuries
Cadaver
Injections
Clinical Studies
Superficial Back Muscles
Plastic Surgery
Ligation
Blood Vessels
Dissection
Anatomy
Spine
Perfusion
Bone and Bones
lead oxide

ASJC Scopus subject areas

  • Surgery

Cite this

Bipedicle paraspinous muscle flaps for spinal wound closure : An anatomic and clinical study. / Wilhelmi, B. J.; Snyder, N.; Colquhoun, T.; Hadjipavlou, A.; Phillips, Linda.

In: Plastic and Reconstructive Surgery, Vol. 106, No. 6, 2000, p. 1305-1311.

Research output: Contribution to journalArticle

Wilhelmi, BJ, Snyder, N, Colquhoun, T, Hadjipavlou, A & Phillips, L 2000, 'Bipedicle paraspinous muscle flaps for spinal wound closure: An anatomic and clinical study', Plastic and Reconstructive Surgery, vol. 106, no. 6, pp. 1305-1311.
Wilhelmi, B. J. ; Snyder, N. ; Colquhoun, T. ; Hadjipavlou, A. ; Phillips, Linda. / Bipedicle paraspinous muscle flaps for spinal wound closure : An anatomic and clinical study. In: Plastic and Reconstructive Surgery. 2000 ; Vol. 106, No. 6. pp. 1305-1311.
@article{3be831ac682d47c4983ac39dd94ba0bf,
title = "Bipedicle paraspinous muscle flaps for spinal wound closure: An anatomic and clinical study",
abstract = "The purpose of this study was to evaluate the vascular anatomy of the paraspinous muscles and review their clinical use as bipedicled flaps in spinal wound closure. Anatomically, through cadaver dissections, lead oxide injections, and radiographic imaging, the blood supply to the paraspinous muscles was determined. Clinically, 29 consecutive patients treated with spinal wounds and exposed bone or hardware were reviewed retrospectively. Of these patients, 19 underwent closure in delayed primary fashion, whereas 10 were referred to plastic surgery for reconstruction because of the complex nature of their wounds. The cadaver study demonstrated the paraspinous muscles to possess a segmental arterial supply through medial and lateral perforators. Division of the medial perforators allowed for medial advancement of the muscles. Lead oxide injection of the lateral perforators demonstrated adequate medial muscle perfusion with ligation of the medial perforators. Ten of the 29 patients (six women, four men, 32 to 62 years of age) were reconstructed with paraspinous (eight), latissimus (one), and trapezius (one) muscle flaps. A higher complication rate was found in wounds closed in delayed primary fashion (13 of 19 patients, 68 percent) than those reconstructed with muscle flaps (2 of 10 patients, 20 percent) (p = 0.021). Follow-up of the muscle flap reconstructed patients averaged 12 months (range, 3 to 27 months). Cadaver muscle injections predicted and clinical cases confirmed that the paraspinous muscles can be raised on lateral perforators and advanced medially to close lumbar spine wounds reliably with fewer complications.",
author = "Wilhelmi, {B. J.} and N. Snyder and T. Colquhoun and A. Hadjipavlou and Linda Phillips",
year = "2000",
language = "English (US)",
volume = "106",
pages = "1305--1311",
journal = "Plastic and Reconstructive Surgery",
issn = "0032-1052",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Bipedicle paraspinous muscle flaps for spinal wound closure

T2 - An anatomic and clinical study

AU - Wilhelmi, B. J.

AU - Snyder, N.

AU - Colquhoun, T.

AU - Hadjipavlou, A.

AU - Phillips, Linda

PY - 2000

Y1 - 2000

N2 - The purpose of this study was to evaluate the vascular anatomy of the paraspinous muscles and review their clinical use as bipedicled flaps in spinal wound closure. Anatomically, through cadaver dissections, lead oxide injections, and radiographic imaging, the blood supply to the paraspinous muscles was determined. Clinically, 29 consecutive patients treated with spinal wounds and exposed bone or hardware were reviewed retrospectively. Of these patients, 19 underwent closure in delayed primary fashion, whereas 10 were referred to plastic surgery for reconstruction because of the complex nature of their wounds. The cadaver study demonstrated the paraspinous muscles to possess a segmental arterial supply through medial and lateral perforators. Division of the medial perforators allowed for medial advancement of the muscles. Lead oxide injection of the lateral perforators demonstrated adequate medial muscle perfusion with ligation of the medial perforators. Ten of the 29 patients (six women, four men, 32 to 62 years of age) were reconstructed with paraspinous (eight), latissimus (one), and trapezius (one) muscle flaps. A higher complication rate was found in wounds closed in delayed primary fashion (13 of 19 patients, 68 percent) than those reconstructed with muscle flaps (2 of 10 patients, 20 percent) (p = 0.021). Follow-up of the muscle flap reconstructed patients averaged 12 months (range, 3 to 27 months). Cadaver muscle injections predicted and clinical cases confirmed that the paraspinous muscles can be raised on lateral perforators and advanced medially to close lumbar spine wounds reliably with fewer complications.

AB - The purpose of this study was to evaluate the vascular anatomy of the paraspinous muscles and review their clinical use as bipedicled flaps in spinal wound closure. Anatomically, through cadaver dissections, lead oxide injections, and radiographic imaging, the blood supply to the paraspinous muscles was determined. Clinically, 29 consecutive patients treated with spinal wounds and exposed bone or hardware were reviewed retrospectively. Of these patients, 19 underwent closure in delayed primary fashion, whereas 10 were referred to plastic surgery for reconstruction because of the complex nature of their wounds. The cadaver study demonstrated the paraspinous muscles to possess a segmental arterial supply through medial and lateral perforators. Division of the medial perforators allowed for medial advancement of the muscles. Lead oxide injection of the lateral perforators demonstrated adequate medial muscle perfusion with ligation of the medial perforators. Ten of the 29 patients (six women, four men, 32 to 62 years of age) were reconstructed with paraspinous (eight), latissimus (one), and trapezius (one) muscle flaps. A higher complication rate was found in wounds closed in delayed primary fashion (13 of 19 patients, 68 percent) than those reconstructed with muscle flaps (2 of 10 patients, 20 percent) (p = 0.021). Follow-up of the muscle flap reconstructed patients averaged 12 months (range, 3 to 27 months). Cadaver muscle injections predicted and clinical cases confirmed that the paraspinous muscles can be raised on lateral perforators and advanced medially to close lumbar spine wounds reliably with fewer complications.

UR - http://www.scopus.com/inward/record.url?scp=0033757331&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033757331&partnerID=8YFLogxK

M3 - Article

C2 - 11083560

AN - SCOPUS:0033757331

VL - 106

SP - 1305

EP - 1311

JO - Plastic and Reconstructive Surgery

JF - Plastic and Reconstructive Surgery

SN - 0032-1052

IS - 6

ER -