Technique refinement for complex locoregional reconstruction after spine surgery: Optimization of closed suction drain use

Abstract

Introduction

Plastic surgeons have become increasingly involved in the locoregional closure of spinal wounds after instrumentation, which has proven to minimize postoperative complications, especially among high-risk patient populations. Therefore, optimization and standardization of surgical techniques, including drain placement, for complex spine closure remain paramount. This study aims to investigate drain usage after plastic surgery closure for spine wounds to identify risk factors for postoperative complications that may provide insight to further guide intraoperative decision making.

Methods

An IRB-approved retrospective chart review was conducted to identify 174 consecutive patients who underwent spinal instrumentation with plastic surgery-assisted locoregional flap closure performed at a tertiary academic medical center between January 2016 and July 2021.

Results

Patients who underwent locoregional complex closure of spinal wounds with a single drain (n = 89) demonstrated a lower incidence of infection (4.5% versus 16.5%, p = 0.01) and wound dehiscence (1.1% versus 9.4%, p = 0.02) when compared with the multidrain cohort (n = 85) via univariate and binomial regression analysis. The depth of infection (superficial versus deep) did not vary between groups. Seroma rates were comparable (13.5% versus 15.3%, p = 0.76). Longer time interval to drain removal (>3 weeks) was found to increase the risk of infection.

Conclusion

Our results suggest that the use of multiple drains after locoregional closure of spinal wounds may confer an increased risk of surgical site infection, without theorized protection from seroma formation. In addition, the duration of drain placement should be used to guide the timing of drain removal, instead of daily output.