Coverage of midline posterior wounds presents a challenge to the recon
structive surgeon, especially when spinal stabilization hardware has b
een present and exposed in the wound. Most commonly those wounds that
involve the mid to upper thoracic spine have been covered by latissimu
s dorsi muscle or musculocutaneous flaps. Lower midline wounds, especi
ally in the thoracolumbar region, have needed more complex means of co
verage. These have included reversed latissimus dorsi flaps, free flap
s, extended intercostal flaps, or fasciocutaneous rotation flaps. We h
ave utilized a far simpler and effective muscle flap: the paraspinous
muscle flap. We have raised paraspinous muscle flaps bilaterally and h
ave been able to cover a number of difficult wounds. The wounds were p
resented by 8 patients with exposed Harrington rods, 3 patients with c
erebrospinal fluid leaks, and 1 patient with exposed spinous processes
. The wounds in 5 of these 12 patients were in the upper thoracic regi
on, where a latissimus flap was utilized as an additional layer of mus
cle coverage. The other seven patients had wounds in the lower midline
region below the potential reach of the latissimus dorsi, In the latt
er patients the only flaps employed were paraspinous muscle flaps. We
had only one failure in all patients, which involved a recurrent cereb
rospinal fluid leak in which there was no decompression of the cerebro
spinal fluid pressure utilized in the immediate postoperative period t
o protect the dural repair. In that instance, a leak recurred. This pa
per presents the method of flap elevation and the results of our serie
s.