Zig-Zag Incision for Complex Posterior Spine Procedures

BACKGROUND

Wound-related complications are common following complex posterior spine procedures and may result in the need for serial debridements, prolonged drainage and may place the metalwork at risk. Plastic surgeons have long used a zig-zag incision for certain hand surgery¹ and, more recently, the incision has been described for scalp incisions in paediatric neurosurgery.²

TECHNIQUE

The proposed incision is marked on the skin (Fig. 1). Angles of 45–60° are used. The incision straddles the deformity such that the points of the zig-zag are away from the most at-risk skin. The vertical length of the incision is not changed.

Figure 1.

Zig-zag incision marked on the skin.

Full-thickness skin flaps are then raised exploiting the plane above the lumbar fascia. Each skin flap is then wrapped in a damp swab which is sewn in situ to protect and retract the flap throughout the procedure (Fig. 2). Exposure of the posterior spine is then performed with paraspinal muscle stripping. The wound is closed with either clips or non-absorbable sutures.

Figure 2.

Skin flap is wrapped in a damp swab which is sewn in situ to protect and retract the flap.

DISCUSSION

This technique has been successfully used in our practice to provide soft tissue coverage of metalwork in patients where satisfactory wound closure is difficult, thus reducing wound complications after complex posterior spine surgery. It allows standard exposure of the spine and produces a cosmetically acceptable scar (Fig. 3). This incision is recommended for cases where there is greater potential for wound breakdown, such as oncology patients, and those with gross deformity or a low body mass index.

Figure 3.

Postoperative scar.