J Korean Neurosurg Soc.  2012 Oct;52(4):423-426. 10.3340/jkns.2012.52.4.423.

Reverse Latissimus Dorsi Muscle Flap for an Extensive Soft Tissue Defect Accompanied by Infectious Spondylitis

• Yoo CM
• Kang DH
• Hwang SH
• Park KB

• KMID: 2190666
• DOI: http://doi.org/10.3340/jkns.2012.52.4.423

Abstract

Spinal infection is an inflammatory process around the vertebral body, and it can extend to the epidural space, posterior elements and paravertebral soft tissues. Infectious spondylitis is a rare infectious disorder, which is often associated with significant neurologic deficits and mortality. When an extensive soft tissue defect is accompanied by infectious spondylitis, effective infection control and proper coverage of soft tissue are directly connected to successful outcomes. However, it is not simple to choose the appropriate treatment methods for infectious spondylitis accompanied by a soft tissue defect. Herein, we report a case of severe infectious spondylitis that was accompanied by an extensive soft tissue defect which was closed with a reverse latissimus muscle flap after traumatic spinal epidural hemorrhage.

Keyword

Infectious; Spondylits; Latissimus dorsi muscle; Flap

MeSH Terms

Epidural Space
Hematoma, Epidural, Spinal
Infection Control
Muscles
Neurologic Manifestations
Spondylitis

Figure

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  Fig. 1 Preoperative MRI shows abnormal signal intensities in the dead space between the intra-/inter-muscular area and the scar of previously embolized AVF on L4 body, and shows a loculated fluid collection in the back, spine, paraspinal space through the L4 to L5 level. The dead space reveals a hyperintense signal on sagittal T2-WI (A and D), a hypointense signal on T1-WI (B and E), and is peripherally well-enhanced after gadolinium administration (C and F). MRI : magnetic resonance images, AVF : arteriovenous fistula, WI : weighted image.

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  Fig. 2 Itraoperative photographs : After confirming the inferior border of the latissimus dorsi muscle (arrow), the muscle was dissected from superior to midline part. Then, the dissected part from margin including fascia were lifted. The exposed part with septocutaneous vascular bundle was tunneled to the lower back area, which was the defect site, to cover the extensive soft tissue defect.

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  Fig. 3 The dead space including fluid collection were filled with RLDMF, when comparing the T2-WI (A and D) and T1-WI (B and E) of pre- and post operative MRI, which was taken 6 months after staged operation and antibiotics therapy. Also, there is no residual cavitory lesion on lumbar area. In addition, enhanced area around the dead space after gadolinium injection (C and F) is not enhanced after successful infection control without evident infection sign. RLDMF : reverse latissimus dorsi muscle flap, MRI : magnetic resonance images, WI : weighted image.

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  Fig. 4 Postoperative radiographs show multiple posterior lumbo-sacro-pelvic fixation with anterior column reconstruction and good correction of the deformity.

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