S. Chilukuri1, J. DeCicco1, M. Al-Hamad Daubs1, P. Bolognese2, G. Xipoleas1 1Icahn School of Medicine at Mount Sinai, South Nassau, Division Of Plastic Surgery, Oceanside, NY, USA 2Icahn School of Medicine at Mount Sinai, South Nassau, Division Of Neurosurgery, Oceanside, NY, USA
Introduction:
Patients with Arnold Chiari Malformation (CM) often suffer concurrently with Ehlers Danlos Syndrome (EDS), thus leading to wound healing complications after various surgeries. These complications are highly evident in the setting of cervical and lumbar spinal fusion. Many techniques have been attempted to reduce the risk of post-operative wound healing complications in this patient population. The use of myofascial flaps, a paraspinal flap in particular, is believed to reduce these post-operative complications and improve morbidity in patients with CM and EDS. The authors reviewed all postoperative complications in this patient population who underwent bilateral paraspinal muscle flap reconstruction.
Methods:
This study cohort consists of patients who underwent bilateral paraspinal muscle flap reconstruction after posterior spinal fusion for CM with EDS between the years of 2016-2024. Retrospective cohort study was performed of 556 patients and post-operative complications such as seroma, hematoma, surgical site infection, wound dehiscence, bone matrix infection, and return to operating room were analyzed. Patients who had prior surgery at the same location, had a CSF leak, or had chronic pressure injuries after surgery were excluded from this study.
Results:
The retrospective cohort study consisting of 556 patients and complication rates were compared to a literature review consisting of patients with EDS and postoperative complications. Retrospective cohort study vs literature review, respectively, shows rates of wound dehiscence (1.6% vs 6.9%), hematoma formation (0.53% vs 3.3%), seroma formation (2.5% vs 2.9%), surgical site infection (1.40% vs 4.5%), bone matrix infection/hardware removal (0.36% vs 2%), and return to OR (3.10% vs 4.25%). Notably, patients in our study who underwent bilateral paraspinal myofascial flaps had fewer wound complications compared to literature review, thus validating the benefit of myofascial flaps in patients with connective tissue disorders.
Conclusion:
Using a paraspinal muscle flap reconstruction for posterior spinal fusion cases in patients with connective tissue disorders such as EDS will reduce the number of post-operative complications. It is evident based on our study that postoperative complications are reduced compared to simple primary repair when compared to literature review. It is also important to note there is limited literature on the topic of spinal reconstruction in patients with EDS and complication rates. Majority of complications are noted in orthopedic literature and there is a need for expansion of this research in the plastic surgery setting. Therefore, we believe our eight-year, large scale cohort study is able to demonstrate the benefit of paraspinal myofascial flaps in EDS when undergoing posterior spinal surgery.