PURPOSE: Complex spinal surgery in the pediatric population can lead to devastating complications and morbidity. Paraspinal muscle flaps are commonly performed after complications to optimize wound closure. However, some advocate for their prophylactic use at the index surgery. The aim of this study is to determine the utility of immediate muscle flaps in pediatric spine surgery.
METHODS: A retrospective cohort study was performed using data from the Pediatric National Surgical Quality Improvement Program (PNSQIP) database. Patients who underwent complex spinal surgery from 2016 to 2021 were queried and split into cohorts based on if muscle flaps were performed at the index surgery. Primary outcomes compared incidence of surgical site infections (SSI) and wound complications.
RESULTS: There were 43,678 patients who underwent spinal surgery. Of these, 847 (1.9%) had concomitant paraspinal flaps. There was no significant difference in superficial SSIs (p=.18). Deep wound infections were significantly more common in the muscle flap group (no flap: 0.7% vs flap: 1.9%; p<.001), as were deep organ space infections (no flap: 0.4% vs flap: 1.5%; p<.001). Notably, muscle flaps were performed more in high-risk patients determined by ASA (American Society of Anesthesiologists) class and these patients experienced significantly more complications overall (rate of SSI- ASA 1: 1.1% vs ASA 4: 5.6%; p<.001).
CONCLUSION: Patient selection may determine the need for prophylactic muscle flaps, likely favoring more complex patients. These patients may experience more postoperative infections, validating the decision to perform a muscle flap at the time of index operation.