Workup
Laboratory Studies
- Blood: Complete blood count and routine blood chemistry usually are required. In some specific situations, a complete metabolic profile, coagulation profile, and blood cultures may be indicated.
Imaging Studies
- Radiograph
- CT scan
- MRI
- Myelogram
Histologic Findings
Perform biopsy on chronic nonhealing wounds to exclude the presence of squamous cell carcinoma (ie, Marjolin ulcer).
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References
Vyas SC, Binns JH, Wilson AN. Thoracolumbar-sacral flaps in the treatment of sacral pressure sores. Plast Reconstr Surg. Feb 1980;65(2):159-63. [Medline].
Angrigiani C, Grilli D, Siebert J. Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg. Dec 1995;96(7):1608-14. [Medline].
Blaiklock CR, Demetriou EL, Rayner CR. The use of a latissimus dorsi myocutaneous flap in the repair of spinal defects in spina bifida. Br J Plast Surg. Jul 1981;34(3):358-61. [Medline].
Bostwick J 3rd, Scheflan M, Nahai F, et al. The "reverse" latissimus dorsi muscle and musculocutaneous flap: anatomical and clinical considerations. Plast Reconstr Surg. Apr 1980;65(4):395-9. [Medline].
Nahai F, Hagerty R. One-stage microvascular transfer of a latissimus flap to the sacrum using vein grafts. Plast Reconstr Surg. Feb 1986;77(2):312-5. [Medline].
Stevenson TR, Rohrich RJ, Pollock RA, et al. More experience with the "reverse" latissimus dorsi musculocutaneous flap: precise location of blood supply. Plast Reconstr Surg. Aug 1984;74(2):237-43. [Medline].
Baran CN, Celebioglu S, Civelek B, et al. Tangentially split gluteus maximus myocutaneous island flap based on perforator arteries for the reconstruction of pressure sores. Plast Reconstr Surg. Jun 1999;103(7):2071-6; quiz 2077. [Medline].
Ramirez OM, Orlando JC, Hurwitz DJ. The sliding gluteus maximus myocutaneous flap: its relevance in ambulatory patients. Plast Reconstr Surg. Jul 1984;74(1):68-75. [Medline].
Kroll SS, Rosenfield L. Perforator-based flaps for low posterior midline defects. Plast Reconstr Surg. Apr 1988;81(4):561-6. [Medline].
Ao M, Mae O, Namba Y, et al. Perforator-based flap for coverage of lumbosacral defects. Plast Reconstr Surg. Apr 1998;101(4):987-91. [Medline].
Daniel RK, Kerrigan CL, Gard DA. The great potential of the intercostal flap for torso reconstruction. Plast Reconstr Surg. May 1978;61(5):653-65. [Medline].
Evans GR, Reece GP. Lower back reconstruction: an approach to wound closure in the cancer patient. Plast Reconstr Surg. Sep 1995;96(3):635-42. [Medline].
Fiala TG, Buchman SR, Muraszko KM. Use of lumbar periosteal turnover flaps in myelomeningocele closure. Neurosurgery. Sep 1996;39(3):522-5; discussion 525-6. [Medline].
Hill C, Riaz M. A new twist to the myocutaneous turnover flap for closure of a spinal defect. Plast Reconstr Surg. Sep 1998;102(4):1167-70. [Medline].
Hill HL, Brown RG, Jurkiewicz MJ. The transverse lumbosacral back flap. Plast Reconstr Surg. Aug 1978;62(2):177-84. [Medline].
Hung SJ, Chen HC, Wei FC. Free flaps for reconstruction of the lower back and sacral area. Microsurgery. 2000;20(2):72-6. [Medline].
Iacobucci JJ, Marks MW, Argenta LC. Anatomic studies and clinical experience with fasciocutaneous flap closure of large myelomeningoceles. Plast Reconstr Surg. Jun 1996;97(7):1400-8; discussion 1409-10. [Medline].
Kato H, Hasegawa M, Takada T, et al. The lumbar artery perforator based island flap: anatomical study and case reports. Br J Plast Surg. Oct 1999;52(7):541-6. [Medline].
Moore TS, Dreyer TM, Bevin AG. Closure of large spina bifida cystica defects with bilateral bipedicled musculocutaneous flaps. Plast Reconstr Surg. Feb 1984;73(2):288-92. [Medline].
Mustarde JC. Reconstruction of the spinal canal in severe spina bifida. Plast Reconstr Surg. Aug 1968;42(2):109-14. [Medline].
Ramirez OM, Ramasastry SS, Granick MS, et al. A new surgical approach to closure of large lumbosacral meningomyelocele defects. Plast Reconstr Surg. Dec 1987;80(6):799-809. [Medline].
Roche NA, Van Landuyt K, Blondeel PN, et al. The use of pedicled perforator flaps for reconstruction of lumbosacral defects. Ann Plast Surg. Jul 2000;45(1):7-14. [Medline].
Thomas CV. Closure of large spina bifida defects: a simple technique based on anatomical details. Ann Plast Surg. Dec 1993;31(6):522-7. [Medline].
Verpaele AM, Blondeel PN, Van Landuyt K, et al. The superior gluteal artery perforator flap: an additional tool in the treatment of sacral pressure sores. Br J Plast Surg. Jul 1999;52(5):385-91. [Medline].
Wendt JR, Gardner VO, White JI. Treatment of complex postoperative lumbosacral wounds in nonparalyzed patients. Plast Reconstr Surg. Apr 1998;101(5):1248-53; discussion 1254. [Medline].
Wilhelmi BJ, Snyder N, Colquhoun T, et al. Bipedicle paraspinous muscle flaps for spinal wound closure: an anatomic and clinical study. Plast Reconstr Surg. Nov 2000;106(6):1305-11. [Medline].
Further Reading
Keywords
back reconstruction, complex posterior trunk defects, posterior trunk defects, trunk repair, muscle-based flaps, perforator-based flaps, free tissue transfer, spina bifida, skin graft, skin flaps, Limberg flaps, rhomboid flap, skin rotation flap, thoracolumbar sacral skin flap, transverse lumbosacral back flap, intercostal neurovascular island skin flap, scapular and parascapular flap, tissue expansion, muscle flap, myocutaneous flap, trapezius flap, latissimus dorsi flap, bilateral advancement flap, bilateral bipedicle myocutaneous flap, latissimus dorsi triangular island advancement flap, serratus anterior, gluteus maximus flap, segmental muscle flap, paraspinous muscle flap, fasciocutaneous flap, paralumbar flap, gluteal thigh flap, perforator flap, periosteal flap, osteocutaneous flap, osteomuscular flap, osseomusculocutaneous flap, omental flap, free flap, innervated flap, filleted leg tissue
Workup: Back Reconstruction