Effects of Negative Pressure Wound Therapy on Wound Dehiscence and Surgical Site Infection Following Instrumented Spinal Fusion Surgery—A Single Surgeon's Experience

Vascularized Muscle Flap to Reduce Wound Breakdown During Flexible Electrode-Mediated Functional Electrical Stimulation After Peripheral Nerve Injury

“…Negative pressure wound therapy (NPWT) has been described as a tool to treat dehiscence and surgical site infections (SSIs). Recently, NPWT has been described for its role in preventing dehiscence and SSIs of closed incisions following instrumented spinal fusion surgery (47). During incisional NPWT, the wound is covered with a moist sterile gauze, sealed with an adhesive tape and connected to a vacuum pump using a drainage hose.…”

“…The mechanism by which incisional NPWT facilitates wound healing is through maintenance of a sterile field, decreased tension across the incision, removal of fluid from the wound edges, reduced pathogen burden and promotion of granulation tissue via angiogenesis ( 48 – 50 ). Naylor et al ( 47 ) showed prevention of increased rates of dehiscence and SSI among patients undergoing lumbar fusion through an anterior approach and there are currently two ongoing clinical trials to further investigate the efficacy of NPWT in spinal fusion surgery (NCT03820219 and NCT03632005).…”

Surgical Site Infection Prophylaxis and Wound Management in Spine Surgery

“…Deep wound vacuum assisted closure (VAC; Kinetic Concepts Inc., San Antonio, TX, USA) is another important postoperative tool for both, managing and preventing SSI. VACs are a form of negative pressure wound therapy (NPWT) that uses negative pressure to close dead spaces, maintain the sterile field, improve wound vascularity, increase skin perfusion, and clear infections [75][76][77]. To place a VAC, the surgeon inserts a foam dressing that has been cut into the shape of the wound, allowing it to compress along the complete surface area of the lesion.…”

“…A 2020 retrospective cohort study of a single surgeon suggested that NPWT reduces the risk of dehiscence and SSI when used in a high-risk population (patients with neoplasm or infection, long incisions, long fusion constructs, intraoperative durotomy, etc.) [ 77 ]. It is noteworthy that NPWT was demonstrated safe in a population of patients with deep SSI and durotomy: it did not result in CSF-related complications [ 83 ].…”

Negative Pressure Wound Therapy in Spinal Surgery

“…However, not all evidence supports the use of NPWT as an infection prevention strategy. Naylor et al reported that, although NPWT was used selectively in patients felt to be at especially high risk of postoperative wound complications, the incidence of wound dehiscence and SSI was 5.6% in the non-NPWT group and 5.7% in the NPWT group ( p = 0.98) in a retrospective study of a single surgeon’s experience with NPWT [ 60 ].…”