The Use of Vacuum Dressings for Dead Space Management in Deep Surgical Site Infections Allows Implant and Bone Graft Retention

Abstract

Study Design:Retrospective, descriptive study.Objectives:Managing early surgical site infection following elective lumbar spine surgery remains a challenge with controversy regarding retention of instrumentation and bone graft. Wound closure may also pose considerable challenges. We aim to report on our method of managing deep surgical site infections complicating elective spine surgery with surgeon assembled deep vacuum dressings. Identification of causative organisms with their sensitivities was a secondary objective.Methods:Patients were identified from a prospectively maintained, single-surgeon database from 2003-2015. Patients who had an infective or trauma related diagnosis, cervical procedures, and were younger than 18 years were excluded. Records were reviewed to identify bacteriology, laboratory tests performed, antibiotics administered, and type and frequency of surgical management. One thousand two hundred twenty patients qualified for inclusion, with 19 identified as having developed acute wound sepsis.Results:All patients had surgical debridement on the day of presentation and the majority of wounds were managed with a vacuum dressing. In all but 1 patient was instrumentation retained. Specimens for culture were taken at each debridement and antibiotics changed accordingly. Patients received a minimum 6 weeks of antibiotics.Conclusions:The management of deep surgical site infection is labor intensive and frustrating for both surgeon and patient due to the unexpected prolonged admission. Management goals are identification and eradication of the causative organism with subsequent healing of the surgical wound. This process is enhanced with the use of negative-suction dressings made from theatre stock replaced at regular intervals and allows retention of bone graft and instrumentation in the majority of cases.

Negative Pressure Wound Therapy in Spinal Surgery

“…In 2017, Watt et al discussed the advantages of NPWT in managing deep SSI after surgery specifically when it comes to the management of dead space [ 41 ]. Exposure, resection of posterior elements for decompression, and restoration of lordosis make spine surgery especially prone to the formation of dead space, which can lead to the formation of hematomas and ultimately areas for the spread of infection [ 41 ]. The authors posit that vacuum dressings decrease the potential space, remove excess fluid and maintain a lack of tension on surrounding tissues [ 41 ].…”

A Novel Wound and Soft Tissue Flap Negative Pressure Drain System - a Pilot Study

“…Post-operative seroma and/or hematoma formation can place unyielding pressure on overlying tissues and may increase the risk of wound dehiscence [19]. NPWT has been proven to be beneficial for dead-space management in both human and animal models [23,24]. For superficial tissues, incisional NPWT devices alone are often adequate to prevent post-operative, fluid-related complications.…”

Strategies of management of deep spinal infection: from irrigation and debridement to vacuum-assisted closure treatment

“…Implant removal was needed in only one patient. They concluded that this management is effective for deep wound infections after spine surgery and allows graft and instrument retention (30).…”

“…. However, recent improvements in wound care allow implant retention especially for acute deep wound infection(30). Hedequist et al reported 26 delayed deep wound infection cases within 1,771 deformity cases.…”