Therapy of acute and delayed spinal infections after spinal surgery treated with negative pressure wound therapy in adult patients

Abstract

We present the results of the treatment of infected primary or delayed spine wounds after spinal surgery using negative pressure wound therapy. In our institution (University Hospital Zurich, Switzerland) nine patients (three women and six men; mean age 68.6, range 43-87 years) were treated in the period between January to December 2011 for non-healing spinal wounds. The treatment consisted of repeated debridements, irrigation and temporary closure with negative pressure wound therapy system. Three patients were admitted with a spinal epidural abscess; two with osteoporotic lumbar fracture; two with pathologic vertebra fracture and spinal cord compression, and two with vertebra fracture after trauma. All nine patients have been treated with antibiotic therapy. In one case the hardware has been removed, in three patients laminectomy was performed without instrumentation, in five patients there was no need to remove the hardware. The average hospital stay was 16.6 days (range 11-30). The average follow-up was 3.8, range 0.5-14 months. The average number of negative pressure wound therapy procedures was three, with the range 1-11. Our retrospective study focuses on the clinical problems faced by the spinal surgeon, clinical outcomes after spinal surgery followed by wound infection, and negative pressure wound therapy. Moreover, we would like to emphasize the importance for the patients and their relatives to be fully informed about the increased complications of surgery and about the limitations of treatment of these wounds with negative pressure wound therapy.

Instillation negative pressure wound therapy: An effective approach for hardware salvage

“…It has been found to decrease mean time to hospital discharge when compared with traditional wet‐to‐moist wound care or traditional NPWT . VACi has previously been reported as a reasonable therapeutic adjunct for practitioners in the treatment of threatened hardware and/or osteomyelitis, although many of these reports have been smaller case studies . Our study provides a larger single institution sample of patients who had effective hardware retention when VACi was utilised.…”

“…A recent study looking at the effects of VACi on porcine models with infected spinal hardware found that VACi was effective at causing interruptions in the biofilm . VACi is a gentle and effective way to continuously cleanse the wound bed without having to return to the operating room …”

“…3 Vacuum-assisted closure with instillation (VACi), also known as negative pressure wound therapy with instillation, is an adjunctive treatment modality that has been utilised by the authors and has also been reported by several European groups to address hardware infections, although most studies to date have been small case series. 2,[9][10][11][12][13] As compared with traditional negative pressure wound therapy (NPWT), VACi utilises foam that is more hydrophilic with a higher tensile strength so that it can be more easily removed from the wound bed (Figures 1 and 2). At set intervals, a solution is introduced into the wound through an instillation port on the foam.…”

“…20 VACi is a gentle and effective way to continuously cleanse the wound bed without having to return to the operating room. 2,[9][10][11][12][13] Several solutions have been used for instillation in VACi. Common examples include saline, hypochlorite solution (Dakin's), antiseptics (Prontosan [B. Braun Medical, Melsungen, Germany]), hypochlorous acid (Vashe, SteadMed Medical, Fort Worth, TX), and antibiotic irrigation solutions.…”

Management of Metastatic Tumours to the Cervical Spine

“…Treatment with local irradiation is associated with some major complications e.g., wound infections. Risk of developing wound infection is increased because of malnutrition, compromised immunological status in cancer patients as well as preoperative irradiation [23]. New minimally invasive spinal techniques allow us faster recovery after surgery and reduction of postoperative complications related to immobilization (e.g., pneumonia, pulmonary embolism, deep venous thrombosis and wound breakdowns).…”