Clinical Presentation
A 52-year-old White male underwent C4–C7 posterior cervical fusion 4 months previously. He was discharged home and subsequently had wound dehiscence and drainage from his neck wound. He was seen in outpatients by the orthopedic spine service and was admitted to the hospital directly for debridement, intravenous antibiotic treatment, and definitive wound closure. The plastic surgery service was consulted for this complex wound closure and after evaluating the wound, bilateral adjacent flaps for wound closure were planned ( Fig. 13.1 ).
Operative Plan and Special Considerations
Before the definitive wound closure, the patent was brought to the operating room by the plastic surgery service for more definitive wound debridement and preparation of the wound bed for flap reconstruction. A vacuum-assisted closure was placed after the definitive wound debridement and an operative plan was made during this procedure. Based on the size and location of the skin defect in the area, bilateral trapezius myocutaneous advancement flaps could be an excellent option for soft tissue coverage. The cervical portion of the muscle flap can be raised as a myocutaneous flap from each side and approximated in the midline of the posterior neck. Bilateral trapezius myocutaneous flaps can provide a three-layer closure including the muscle, subcutaneous layer, and skin and can be an excellent option for a complex midline posterior neck wound reconstruction.
Operative Procedures
Under general anesthesia, the patient was placed in the prone position. The posterior neck wound was 4 cm in diameter ( Fig. 13.2 ). The wound edges were sharply debrided to remove unhealthy-looking skin and subcutaneous tissue. The underlying exposed bone was also debrided along with surrounding nonviable tissue, with curette for the bone and electrocautery for the subcutaneous tissue and muscle.
