Paraspinal Advancement Flap for Back Reconstruction

Abstract

The paraspinal advancement flap can provide muscle coverage for midline posterior defects. The procedure is performed under general anesthesia in the prone position. It is critical to ensure adequate debridement of any devitalized or necrotic tissue. The paraspinal muscles are located by incising the thoracolumbar fascia medially. If the wound is chronic, incisions may need to be extended proximally or distally to identify normal tissue planes. Paraspinal muscles are released from their origin on the spine. This is bluntly elevated from the transverse processes mobilizing the muscle medially to laterally. Skin and subcutaneous tissue is undermined in a supra-fascial plane to allow primary closure. Alternatively, a turnover flap can be performed by making the initial fascial incisions on the lateral aspect of the erector spinae fascia, elevating the muscle groups from lateral to medial (preserving the medial perforator row), and transposing the lateral edges of bilateral muscle flaps toward the midline.

Possible complications include infection, bleeding, wound dehiscence or recurrence, hematoma, seroma, flap necrosis, or rarely meningitis.