Repair methods and effects of refractory wounds in patients after spinal internal fixation operation
Objective To explore the repair methods and effects of refractory wounds in patients after spinal internal fixation operation.Methods The study was a retrospective observational study.From November 2020 to October 2023,10 patients with refractory wounds after spinal internal fixation operation were admitted to the Department of Burns and Plastic Surgery of Changde Hospital of Xiangya School of Medicine of Central South University.They were 3 males and 7 females,aged 35 to 68 years.There were 6 cases of thoracolumbar tuberculosis,3 cases of thoracolumbar fracture,and 1 case of recurrent sacrococcygeal chordoma with skin,soft tissue,and bone defects after radical resection.The wound areas after debridement were 6.0 cm× 1.5 cm to 27.0 cm×6.5 cm.The wound repair operation was decided to perform in the primary stage or in the secondary stage according to the wound situation.Two patients with type Ⅰ wounds were treated with debridement,direct suture,and continuous irrigation and drainage with catheter after operation.Eight patients with type Ⅱ wounds were repaired with local flaps(including rotation flap with dermis-fat flap at the end),muscle flaps,or muscle flaps combined with local flaps.The flap sizes were 10.0 cm×5.0 cm to 27.0 cm×14.0 cm,and the sizes of muscle flap were 8.0 cm×5.0 cm× 4.0 cm to 17.0 cm×9.5 cm×2.0 cm.The wounds in flap donor areas were sutured directly.The wound treatment methods of patients with type Ⅱ wounds were recorded.The wound healing was observed after operation.The infection and recurrence of wounds,the retention of internal fixation materials,and spinal motor function were observed during follow-up.Results Among patients with type Ⅱ wounds,there were 3 cases applied with local flaps(including 1 case with rotation flap with dermis-fat flap at the end),3 cases with muscle flaps(including 1 case with latissimus dorsi muscle flap and 2 cases with erector spinal muscle flaps),and 2 cases with muscle flaps(1 case with latissimus dorsi muscle flap and 1 case with erector spinal muscle flap)combined with local flaps.Only 1 case with secondary defects after radical surgery of sacrococcygeal chordoma had poor wound healing which healed after dressing change,and the wounds of the remaining 9 cases all healed well.During the follow-up of 4 to 18 months,no infection or recurrence of local wounds developed in 10 patients,the internal fixation materials were not loosening,and there was no significant limitation in spinal motor function.Conclusions For refractory wounds after spinal internal fixation operation,according to the wound type of patients,debridement,suture,irrigation,and drainage in the primary stage,or transplantation of local flaps,muscle flaps,muscle flaps combined with local flaps are performed in the primary stage or in the secondary stage.These methods are proved to have reliable therapeutic effects,not only repairing the wounds,but also retaining the internal fixation materials.
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