Recent Surgical Techniques for Coverage of Lumbosacral Defects
Badr Hammad Mohamad;
Abstract
Defects of the back requiring reconstruction are caused by either a congenital or acquired problem.
Congenital defect including Spina bifida and Giant congenital pigmented nevi.
Spina bifida is the most common birth defect of the central nervous system. Children with spina bifida are born with incomplete fusion of the vertebrae dorsally.
Reconstruction with stable and well-vascularized cover is indicated to prevent infection and to preserve existing functional neural tissue. Most of these defects can be closed easily and are addressed by neurosurgeons however; approximately 25% of defects require plastic surgical expertise.
Giant congenital pigmented nevi can occur over the posterior trunk. The lifetime risk of developing melanoma in these patients may approach 15%. Complete prophylactic excision of the nevi usually is recommended in infancy and early childhood.
Acquired posterior trunk defects result from trauma, infection, burns, radiation, tumor resection, postoperative wound dehiscence, or pressure ulcers.
Reconstructive goals are to protect underlying vital structures, including the spinal cord, and to provide functional support.
Numerous techniques for lumbosacral repair have been described in plastic surgical literature during the past 2-3 decades. Reconstructive techniques have improved in the past few years because of better understanding of anatomy and recognition of vascular territories and angiosomes.
Typically, the reconstructive pyramid has been touted as the best approach to defects. In this pyramid, the reconstruction options begin with local tissue and progress to regional tissue reconstructions, and finally, to free tissue transfer. In many of these patients, however, the ideal approach requires skipping layers on the pyramid and starting with the most complex option.
More extensive use of muscle- and perforator-based flaps and free tissue transfers to provide single-stage, reliable, and stable coverage has changed the outlook of reconstruction in these complex wounds.
Congenital defect including Spina bifida and Giant congenital pigmented nevi.
Spina bifida is the most common birth defect of the central nervous system. Children with spina bifida are born with incomplete fusion of the vertebrae dorsally.
Reconstruction with stable and well-vascularized cover is indicated to prevent infection and to preserve existing functional neural tissue. Most of these defects can be closed easily and are addressed by neurosurgeons however; approximately 25% of defects require plastic surgical expertise.
Giant congenital pigmented nevi can occur over the posterior trunk. The lifetime risk of developing melanoma in these patients may approach 15%. Complete prophylactic excision of the nevi usually is recommended in infancy and early childhood.
Acquired posterior trunk defects result from trauma, infection, burns, radiation, tumor resection, postoperative wound dehiscence, or pressure ulcers.
Reconstructive goals are to protect underlying vital structures, including the spinal cord, and to provide functional support.
Numerous techniques for lumbosacral repair have been described in plastic surgical literature during the past 2-3 decades. Reconstructive techniques have improved in the past few years because of better understanding of anatomy and recognition of vascular territories and angiosomes.
Typically, the reconstructive pyramid has been touted as the best approach to defects. In this pyramid, the reconstruction options begin with local tissue and progress to regional tissue reconstructions, and finally, to free tissue transfer. In many of these patients, however, the ideal approach requires skipping layers on the pyramid and starting with the most complex option.
More extensive use of muscle- and perforator-based flaps and free tissue transfers to provide single-stage, reliable, and stable coverage has changed the outlook of reconstruction in these complex wounds.
Other data
| Title | Recent Surgical Techniques for Coverage of Lumbosacral Defects | Other Titles | التقنيات الجراحية الحديثه لتغطية العيوب القطنيه العجزيه | Authors | Badr Hammad Mohamad | Issue Date | 2015 |
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