Use of biological tissue matrix in postneurosurgical posterior trunk reconstruction is associated with higher wound complication rates

Background: Patients undergoing neurosurgical spine surgery for spinal tumors are increasingly undergoing soft-tissue reconstruction involving the use of biological tissue matrices. There are limited data available on the safety of these devices in posterior trunk reconstruction. Methods: A cohort study of patients undergoing oncologic spine surgery with subsequent plastic surgery soft-tissue reconstruction from 2002 to 2014 was conducted. Demographic, medical, and surgical variables were recorded. The primary outcome variable was development of a postoperative wound complication. Secondary outcome variables were specific complications, including infection, seroma, hematoma, dehiscence, and cerebrospinal fluid leak. The predictor variable was the presence or absence of biological matrix at the reconstruction site. Results: A total of 293 cases in 260 patients were included in this study. The cohorts were similar with regard to demographic, medical, and surgical variables. The incidence of all-cause wound complications in patients receiving biological matrix for reconstruction was 49.2 percent, whereas the all-cause complication rate for patients not receiving the matrix was 31.7 percent (p = 0.010). The rates of infection (34.9 percent versus 20.9 percent) and seroma (19.0 percent versus 10.0 percent) were also increased in patients receiving biological matrix. In multivariate analysis, biological matrix use remained a predictor of wound complications (p = 0.045), infection (p = 0.011), and seroma (p = 0.047). Conclusions: The authors identified an increased risk of infection and seroma with the use of biological tissue matrix in posterior trunk reconstruction. Careful consideration of the risks and benefits of using these devices in this patient population is warranted.