A 56-year-old woman, hypertensive, with a history of poliomyelitis at one year of age and sequelae in the left lower limb that required multiple interventions to enable her to walk properly, as well as lumbar spine surgery at 42 years of age. Diagnosed with spinal pathology of D11-D12 and L3-L4, she underwent L1-L5 pósterolateral arthrodesis plus lamina graft and bone substitute, presenting poor evolution, with infection of the surgical wound and necrosis of the paravertebral musculature that required 3 new interventions to debride the non-viable tissue. After the third operation, she was fitted with a vacuum therapy system and was referred to our department, a reference centre for reconstructive surgery. The time between the first spinal surgery and the time of referral to our department was approximately 18 days.
The patient was transferred on a stretcher as she was unable to ambulate and had significant atrophy in both lower limbs, as well as a defect in the dorso-lumbar area measuring approximately 20 x 5 cm in diameter, with exposure of the spinal column and osteosynthesis material. There were no signs of infection.

We performed a study of the extent of the defect by means of computerised axial tomography (CT), which reported an instrumented arthrodesis from L1-S1 with resection of posterior elements and posterior soft tissue augmentation in the surgical site, with traces of air and soft tissue mass suggesting post-surgical changes, with no evidence of abscesses. We also performed dorsal-lumbar CT angiography to determine the viability of the paravertebral muscle-cutaneous perforators.

We maintained the vacuum therapy system in the surgical wound for 20 days, while imaging and pre-anaesthetic studies were completed, to assist in cleansing the lesion.
Planning of the surgical procedure included debridement of the scar tissue, coverage of the deep bony structures with well-vascularised tissue and closure of the skin defect without tension.
Under general anaesthesia, with the patient in the left lateral decubitus position, we performed excisional debridement of the inverted skin edges and fibrous scar tissue in the lumbar region. We designed and raised a reverse latissimus dorsi muscle flap based on the secondary pedicles, transposed it to the lumbar defect by tunnelling and fixed it to the healthy perilesional muscle tissue. We placed 4 spiral drains, 2 in the donor area and 2 in the recipient area, one in the submuscular plane and the other in the subcutaneous plane.
The donor site was closed directly, in planes, without tension. The skin of the recipient site was closed after Friedrich of the edges, without tension and without compressing the muscle flap.

Five days postoperatively, we observed an increase in the right paravertebral volume after abrupt mobilisation of the patient in bed. Ultrasonography revealed a right paravertebral intramuscular haematoma measuring 15 x 2 cm in size. Under general anaesthesia, we evacuated a coagulated haematoma and checked the viability of the muscle flap, re-closing the wound.
After 18 days, the patient began to walk with the aid of a walker, recovering the functionality of the lower limbs and was discharged on postoperative day 22.
During the 2-year follow-up after surgery, the patient showed normal deambulation and an excellent local evolution of the flap.