O2095: What Is the Role of Plastic Surgery for Incisional Closures in Pediatric Spine Surgery?

Background: Prior studies have reported a benefit to plastic surgery incisional closure following posterior spinal fusion. The impact of these studies on current practice preferences amongst pediatric spine surgeons is unknown. The purpose of this study was to investigate surgeon perceptions with regards to plastic surgery closure in pediatric spine surgery. We hypothesized that wide variability would exist in the perceptions of plastic surgery utilization for incisional closures amongst members of an international pediatric spine study group.

Methods: A 30-question survey was distributed to all surgeon members of an international pediatric spine study group. The survey assessed plastic surgery utilization in adolescent idiopathic scoliosis (AIS), neuromuscular scoliosis (NMS), and early onset scoliosis (EOS) and asked about practices concerning incisional closure, frequency of plastic surgery collaboration, and drain management. Relationship to practice size, practice setting, geographic region, and individual diagnoses were analyzed.

Results: The survey was completed by 87/178 (49%) surgeons, representing 79% of study group sites. All survey respondents (87/87, 100%) had access to a plastic surgeon. Rates of plastics utilization (% of cases) differed by diagnosis: NMS 16.9%, EOS 7.8%, AIS 2.8%, p< 0.0001. The odds of using plastics were significantly higher for both EOS (OR 18.5, 95% CI: [8.5, 40.2], p< 0.001) and NMS (OR 29.2, 95% CI: [12.2, 69.9], p< 0.001) compared to AIS. The use of plastics did not differ based on practice size (p=0.09), practice setting (p=1.0), or geographic region (p=0.25). Respondents used plastics more often for spina bifida and underweight patients when compared to all other indications (p < 0.001). In contrast to orthopaedic management, drains were utilized more often by plastic surgery (85% vs 21%, p=0.06) and for longer durations (p=0.001). 89% of surgeons felt that plastics increased operative time (58±37 minutes, respondents estimated additional time) and 34% felt that plastics involvement increased hospital length of stay. Surgeons who routinely utilize plastics for incisional closures were more likely to believe that plastics closure decreases wound complications (p=0.007).

Conclusion: The results of this study suggest that although access to plastic surgery is widespread, utilization is not. Plastic surgery utilization is most common in neuromuscular scoliosis and least likely in AIS. The perceived benefit of plastic surgery is not unanimous, which highlights the equipoise that exists regarding the benefit of plastics surgery closure amongst pediatric spine surgeons. An evidence-based guideline is needed to provide clarity on the optimal utilization of plastic surgery in pediatric spine surgery.