Cureus. 2018 Nov 14;10(11):e3595. doi: 10.7759/cureus.3595.

Yilmaz E, Tawfik T, O'Lynnger TM, Iwanaga J, Blecher R, Abdul-Jabbar A, Tubbs RS, Schmidt CK, Oskouian RJ, Chapman J.

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Abstract

Meticulous attention to wound closure in posterior lumbar spine surgery is an important principle in reducing surgical site infections. We detail standardized wound closure used for posterior lumbar spine surgery at a tertiary care referral center and illustrate this as a step-by-step cadaveric dissection. The lumbar spine of a cadaveric specimen (male, 73 years at death) was used for dissection. Standardizing wound closure in posterior lumbar spine surgery may help limit wound complications and infection. Some key points of our technique, as demonstrated on a cadaveric specimen, include separating fascial compartments, avoiding suture abscesses, and creating a tension-free wound.

KEYWORDS:

fascia; lumbar; spine surgery; subcutaneous; technique; wound closure

Figure 1

The skin of the lumbar spine is marked with a marking pen

Figure 2

Opening the specimen sharply with a #10 scalpel blade through the epidermis and dermis

Figure 3

Using a Cobb elevator to separate the subdermal fat layer from the deeper fascial layer

Figure 4

Using a #10 scalpel blade and Cobb elevator to dissect the paraspinal musculature in a subperiosteal manner from the spinous processes and laminae

Figure 5

We preserved the supraspinous and interspinous ligaments during the dissection. We took the dissection up to the facet capsules without disrupting the facets

Figure 6

Illustrating the lumbar fascial layer

Figure 7

We then proceeded with wound closure, first using 0 vicryl suture to tightly reapproximate the fascial layer using a simple interrupted technique

Figure 8

Illustrating the single interrupted fascial closure technique

Figure 9

We placed sutures in approximately 1 cm increments and tied four square knots to lock each suture down

Figure 10

We then utilized 2-0 vicryl suture in an inverted manner to close the dermal layer with buried knots, avoiding entry into the epidermal layer

Figure 11

We spaced each of these sutures in 1-cm increments and tied four square knots

Figure 12

Illustrating the inverted dermal closure

Figure 13

We then utilized 3-0 nylon suture in a simple interrupted fashion to reapproximate the skin

Figure 14

The sutures were placed in 1-cm increments

Figure 15

Illustrating the epidermal wound closure