Closing incision during scoliosis surgery reduces complication rates
Patients with scoliosis who undergo surgery may be less likely to develop an infection or other complications after the procedure when a novel wound closure technique is utilised, according to new research published in the Journal of Pediatric Orthopaedics.
In the technique, pioneered at NYU Langone Medical Center, surgeons use a multilayered flap closure that enables them to close several layers of muscle and fascia while maintaining blood supply from the donor site to the recipient site. The researchers believe this new method reduces complication rates by eliminating ‘dead space’, or pockets around spinal hardware and fusion sites where infection can start. The technique also creates a better barrier to separate surgical hardware and bone grafts from the skin’s surface.
“This method for closing incisions after surgery can benefit all patients with scoliosis, especially those most at risk for complications depending on the cause of their spine problems,” said corresponding study author David Feldman, professor of orthopaedic surgery and paediatrics at NYU Langone.
A conventional, non-standardised closure method after scoliosis surgery often involves a bulk skin closure performed by an orthopaedic surgeon where no flaps are mobilised. In this retrospective study, NYU Langone researchers reviewed 76 charts of patients aged eight to 25 years, with non-idiopathic scoliosis who had undergone a posterior spinal fusion surgery. Forty-two patients had their incisions closed using conventional techniques, while 34 underwent the new, multilayered flap technique.
Approximately 19 per cent of patients who underwent the conventional, non-standardised closure methods experienced a wound complication, which was in line with previous estimates of infection rates for people with non-idiopathic scoliosis; however, patients who underwent the novel, multilayered muscle flap closure method experienced a zero per cent complication rate.
“There was a time when complex scoliosis cases, including revision surgery, had infection rates approaching double digits,” said study co-author Thomas Errico, chief of the Division of Spine Surgery at NYU Langone. “We have now lowered infection rates to under one per cent, a remarkable accomplishment thanks to attention to detail and teamwork of the dedicated surgeons in our orthopaedic surgery and plastic surgery departments.”
Source: NYU Langone Medical Center
Reference
Ward JP, Feldman DS, Paul J, et al. Wound closure in nonidiopathic scoliosis: Does closure matter? J Pedatric Orthopaedics,
2015 July 24
