Pedicled Omental Flaps as an Adjunct in the Closure of Complex Spinal Wounds

In Brief Study Design. A retrospective clinical study. Objective. To evaluate the safety and efficacy of using an omental flap in complex spine reconstruction in patients at high-risk for wound dehiscence. Summary of Background Data. Postoperative wound dehiscence represents a major cause of morbidity in patients undergoing instrumented spinal reconstruction. A variety of approaches for the prevention and treatment of this problem have been previously described in the literature; however, the use of omental flaps has received little attention. Methods. In this retrospective analysis, 5 patients were studied both clinically and radiographically. The study population included 4 women and 1 man, with a mean age of 49 years (range, 31–67 years). All patients underwent an omental flap procedure at the time of spinal reconstruction because of significant soft tissue defects or active spinal infection. Mean clinicoradiographic follow-up was 53 months (range, 36–115 months). Results. At the time of follow-up, all patients had well-healed surgical wounds with an acceptable structural and esthetic result. One patient in the study group experienced minor supra-fascial wound dehiscence. In terms of spinal outcome, all patients achieved successful bony arthrodesis; 1 patient, however, developed symptomatic adjacent segment degeneration and was treated by extension of the fusion construct. Conclusion. In patients undergoing thoracolumbar surgery who are at high risk of spinal wound dehiscence, closure using a pedicled omental flap is a viable procedure that may limit the risk of dehiscence and improve outcome. Postoperative wound dehiscence represents a major cause of morbidity in patients undergoing instrumented spinal reconstruction. A variety of approaches for the prevention and treatment of this problem have been previously described in the literature. The authors report the largest experience to date using omental flaps in complex spinal reconstruction.