Reconstructive Flap Coverage

Innovations in oncology, perioperative patient management, and spinal stabilization, which typically include the use of spinal instrumentation, have widened the spectrum of patients deemed suitable candidates for spinal surgery. Spinal defects are frequently encountered after resection of primary tumors or metastases within the vertebral bone. A variety of local flaps, pedicled flaps, and free tissue transfers have been described in the literature as options for soft tissue reconstruction of the posterior trunk. These methods encompass numerous fasciocutaneous as well as myocutaneous flaps. This chapter aims to review recent reports and provide systematic guidance for reconstructive surgeons taking care of patients who require either simultaneous prophylactic coverage or delayed soft tissue reconstruction of such defects. The recommended operative techniques can be stratified in two different manners: either by anatomical region on the back (C1–T7, T7–L1, or L1–S5) or by complexity and efficacy (primary, secondary, tertiary). Larger defects may necessitate combinations of flaps for successful reconstructions, while infected wounds require additional antibiotic treatment. Typically, the instrumentation inserted by the orthopedic surgeon can be salvaged with these approaches while subsequently reducing the risk of neurological injury to the patient. An array of different scenarios and techniques are presented and discussed.