PARASPINOUS MUSCLE FLAPS

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.