Double Hatchet Flap for the Reconstruction of a Posterior Neck Soft Tissue Defect due to Surgical Site Infection After Posterior Cervical Spine Surgery

Study Design: A case report. Objectives: To report a case of reconstruction surgery with a double hatchet flap for a posterior neck soft tissue defect due to a surgical site infection (SSI) after posterior cervical spine surgery in a 72-year-old man. Summary of Literature Review: SSI after spinal surgery may cause devastating complications and is difficult to manage. Posterior cervical surgery is associated with a higher incidence of SSI than the posterior lumbar and anterior cervical approaches. It often requires multiple surgical debridements and long-term antibiotic use. Multiple debridements could lead to irreparable large soft tissue defects requiring reconstruction surgery with local flaps. Materials and Methods: A 72-year-old male patient was referred to our center with tetraplegia (motor 2/5) after slipping down. The patient was diagnosed with a spinal cord injury with degenerative changes, ossification of the posterior longitudinal ligament, and multi-level cervical stenosis. The patient underwent laminectomy and posterolateral fusion via a posterior cervical approach, but starting on the third day after surgery, SSI progressed. Proper antibiotics were used and removal of the infected tissue was performed several times. This resulted in a large soft tissue defect in the posterior neck, and reconstruction surgery using a double hatchet flap was performed. Results: The wound healed well, without any complications. Conclusions: A double hatchet flap can be a simple option available for defects in the posterior cervical region.