Reconstruction of Infected Spinal Wound with Dorsal Intercostal Artery Perforator Flap-A Case Report

以背肋間動脈莖皮瓣重建脊椎術後之感染性困難傷口－病例報告

歐冠伶(Kuang-Ling Ou) ； 歐冠彣(Kuang-Wen Ou) ； 林進達(Chin-Ta Lin) ； 魏林瑰(Lin-Gwei Wei) ； 傅如鵬(Ju-Peng Fu) ； 陳錫根(Shyi-Gen Chen) ； 陳天牧(Tim-Mo Chen) ； 曾元生(Yuan-Sheng Tzeng)

《臺灣整形外科醫學會雜誌》 23卷2期 (2014/06) Pp. 176-181

摘要

背景：近二十年來脊椎手術病患增量。隨著骨科、神經外科脊椎手術的複雜度提高，傷口的併發症常需會診整形外科醫師共同治療，特別是後背部脊椎之感染性困難傷口。除了以抗生素治療行感染控制與適當清創外，及時傷口重建可縮短治療時間及促進傷口癒合。目的及目標：我們呈現脊椎術後深部困難傷口感染，在感染狀況達到相對控制下，以背肋間動脈莖皮瓣重建之成功案例。材料及方法：一位71歲女性因第四、五腰椎滑脫併狹窄造成下背痛及雙下肢麻痛感併神經性跛行，接受減壓及植入物固定手術。在多次清創及抗生術治療後，我們以背肋間動脈莖皮瓣重建之。結果：一年後傷口癒合良好，且感染無復發。結論：藉由背肋間動脈莖皮瓣重建脊椎術後之感染性困難傷口在此例病患上得到良好的結果，因背肋間動脈莖皮瓣在傷口覆蓋和延展性上有其優勢，建議在重建脊椎術後之感染性困難傷口可考慮使用。

並列摘要

Background: The prevalence of spine surgery has increased over the past two decades. Complex surgical techniques have been performed on patients from different disease spectrums. However, for the spinal wounds with infection at the midline, the reconstruction of the exposed infected tissues has become a frequent problem faced by the plastic surgeons. Therefore, strict infection control to improve wound healing is of great importance. In addition, appropriate timing to cover the back wound resulted from spinal infection with suitable flap design is equally crucial. Aim and Objectives: We presented a case with deep wound infection secondary to spinal surgery. We choose the dorsal intercostal artery perforator flap (DICAP) to cover the defect of the back region and it turned out to be a satisfactory result. Materials and Methods: A 71-year-old woman had degenerative spondylolisthesis of L4/5 with spinal stenosis and received posterior decompression and instrumentation by orthopedists. Postoperative wound infection with septic status was noted and we were consulted for wound management. After debridement and vacuum-assisted closure (VAC) system coverage, a DICAP flap was raised for wound reconstruction. Results: The infections of the spine were controlled. And the DICAP flap provided as a reliable and simple option for effective and efficient reconstruction of the difficult spinal wound. Conclusion: Infected wounds that involve large area of the back after spinal surgeries has urged the design of a suitable flap for the prevention of future morbidity or mortality. The DICAP flap serves an optimal fasciocutaneous flap for this purpose. Its largest angiosome and less donor site morbidity make it superior to other musculocutaneous flaps. With better extendibility, the area of coverage is less limited. Therefore, when faced with the infected spinal wound over the back, we prefer the use of DICAP flap.

並列關鍵字

infected spinal wound ； dorsal intercostal artery perforator (DICAP) flap