Vacuum-Assisted Closure: An Effective Technique to Manage Wound Complications After Metastatic Spine Tumour Surgery (MSTS)—A Case Report

Abstract

The management of wound complications following metastatic spine tumor surgery (MSTS) remains a formidable task. Plastic coverage procedures after MSTS are challenging due to unhealthy donor sites following previous radiotherapy and prolonged nonambulation. Negative pressure wound therapy (NPWT) is usually not recommended after MSTS due to fear of tumor seeding and excessive blood loss. However, in certain patients post-MSTS, who may be considered as receiving palliative treatment, NPWT can be effective in managing wound complications. We describe our initial experience with the use of NPWT in a 57-year-old lady diagnosed with multiple lumbar and cervicothoracic vertebral metastases secondary to non-small cell lung carcinoma. She underwent 2 cycles of preoperative radiotherapy followed by decompression and posterior instrumentation of lumbosacral and cervicothoracic regions succeeded by another cycle of radiotherapy. The patient developed wound dehiscence and poly-microbial surgical site infection that was not responsive to regular debridements and antibiotics. Hence, we applied NPWT as an alternative treatment to plastic surgical procedures. The patient clinically improved with a reduced quantity of wound discharge, increased granulation tissue, and a downward trend in the inflammatory markers. Subsequently, wound was secondarily closed after 14 days. The patient was discharged after a total hospital stay of 41 days. The intravenous antibiotics (piperacillin/ tazobactam) were changed to oral (ciprofloxacin) after 6 weeks and continued for 4 months. The patient survived for 3 years without any wound complications. Our case report suggests that NPWT can be a potential treatment option for managing wound complications following MSTS.

Vacuum assisted closure and local drug delivery systems in spinal infections: A review of current evidence

“…Knowing this can in turn help guide patient's expectations before surgery and allow the surgical team to plan ahead on the aggressiveness of debridement required. VAC is also advantageous for use in large wounds as they are able to stimulate granulation tissue in the wound bed, before secondary closure or fitting of a reconstructive graft for definitive wound closure [38 , 39] .…”

“…Hence, the use of VAC in spinal wounds with exposed dura was also a controversial topic due to concerns of cerebrospinal fluid leak or dural tears. However, several recent studies [26 , 39 , 50] have shown the safety and efficacy of VAC even in wounds with exposed dura. Importance should be placed on a watertight dural closure before initiation of VAC therapy [50] .…”

“…Importance should be placed on a watertight dural closure before initiation of VAC therapy [50] . Incorporating the usage of VAC whitefoam [26 , 39] and reduced pressures [26 , 50] have also shown to be able to allow wound healing even in cases with exposed dura, as long as the dura is closed appropriately without any subsequent CSF leak.…”

Successful surgical closure of infected abdominal wounds following preconditioning with negative pressure wound therapy

“…The secondary skin closure was performed 14 days after negative pressure therapy. During the 3-year follow-up, no additional wound infection arose [ 34 ]. Our study emphasizes this finding that secondary skin closure following negative pressure therapy is feasible.…”

Negative Pressure Wound Therapy in Malignancy: Always an Absolute Contraindication?

“… 3 – 5 This has similarly been demonstrated in radiated metastatic wounds. 4 Further, Makler et al 3 used NPWT to promote ingrowth of a dermal regeneration template in a previously irradiated and infected full-thickness calvarial wound from metastatic squamous cell carcinoma. At 6 weeks, there was significant integration of the dermal regeneration template, allowing for closure of the wound.…”