Improved vacuum sealing drainage for treatment of surgical site infection following posterior spinal internal fixation

Abstract

Rationale:Surgical site infection (SSI) following spine surgeries involving internal fixation often require removing the instrument; however, this can cause spinal instability. Previous reports have demonstrated the usefulness of vacuum sealing drainage (VSD) therapy, but the cases require wound opening, aseptic condition to replace the VSD device, and a secondary operation to close the wound. Thus, to improve the VSD treatment and develop a maneuverable procedure, make sense in spine surgery.Patients concerns:A 59-year-old male patient with a T12 vertebral fracture was affected by SSIs after spinal osteotomy with internal fixation.Diagnoses:The patient complained of wound exudation and had a fever 3 weeks after posterior spinal surgery. Initial serum investigations showed elevated white blood cell count and bacterial cultures of wound exudate were positive for Enterococcus faecalis. Therefore, SSI is confirmed.Interventions:The infection was not controlled after 2 debridements, so the patient was treated with VSD treatment. The VSD foam dressings containing a drainage tube were placed into the wound from the exudation site of the wound until they contacted the internal fixation devices. After covering external fixation devices, continuous drainage was performed for 24 h. The VSD device was replaced every 4 to 5 days until the wound effusion stopped. All of the operations were performed at the bedside without complex manipulation or secondary closure under harsh aseptic condition.Outcomes:Wound exudation decreased remarkably and the infection was controlled 2 weeks after the application of VSD treatment. After 5 weeks, inflammatory indicators all decreased to normal levels and the exudate of the wound had stopped. The VSD treatment was then terminated and the drainage site of the wound was sutured. After 7 weeks, complete wound healing was achieved and no infection recurred during the 6-month follow-up.Lessons:VSD could be a reliable treatment for SSIs that require preservation of internal fixation. Complete opening of the wound during the VSD treatment and secondary wound closure surgery were avoided.

The Role of Negative-Pressure Wound Therapy in Patients with Fracture-Related Infection: A Systematic Review and Critical Appraisal

“…The quality differed between studies. Eight studies were of high quality [ 30 – 37 ] (≥7 stars) and four of low quality [ 38 – 41 ] (<7 stars). Case reports were not assessable and therefore considered as low quality.…”

Vacuum Sealing Drainage against surgical site infection after intracranial neurosurgery: a technical note

“…Although widely applied against various organ and tissue infections [18,29], VSD has rarely been reported to exert e cacy against SSIs following intracranial neurosurgery. Allegedly, VSD is e cient against primary thoracolumbar spondylodiscitis [30] and SSIs after posterior spinal internal xation [19]. In this investigation, the applied standard surgery with VSD ensured total restraint and cure of all patient infections, including infections in some patients who succumbed to traditional debridement and drainage treatment failure (Fig.…”

“…Reportedly, a closed-incisional negative pressure therapy eases surgical site infections (SSIs) in spine surgery [17], and negative pressure wound therapy is arguably more effective against SSIs after vascular, abdominal, orthopaedical, and thoracic surgeries than conventional procedures [18]. Vacuum sealing drainage (VSD), a core technique of negative pressure wound therapy, demonstrably exerts therapeutic e cacies against SSIs following spinal surgeries and multiple wound infections [19][20][21]. However, the e cacy and outcome of VSD against SSIs after intracranial neurosurgery is still to be investigated fully.…”