Wound conditioning by vacuum assisted closure (V.A.C.) in postoperative infections after dorsal spine surgery

Abstract

The use of vacuum assisted closure (V.A.C.) therapy in postoperative infections after dorsal spinal surgery was studied retrospectively. Successful treatment was defined as a stable healed wound that showed no signs of acute or chronic infection. The treatment of the infected back wounds consisted of repeated debridement, irrigation and open wound treatment with temporary closure by V.A.C. The instrumentation was exchanged or removed if necessary. Fifteen patients with deep subfascial infections after posterior spinal surgery were treated. The implants were exchanged in seven cases, removed completely in five cases and left without changing in one case. In two cases spinal surgery consisted of laminectomy without instrumentation. In two cases only the wound defects were closed by muscle flap, the remaining ones were closed by delayed suturing. Antibiotic treatment was necessary in all cases. Follow up was possible in 14 patients. One patient showed a new infection after treatment. The study illustrates the usefulness of V.A.C. therapy as a new alternative management for wound conditioning of complex back wounds after deep subfascial infection.

Negative pressure wound therapy (NPWT) for spinal wounds: a systematic review

“…Most studies reported that the NPWT dressing was placed in theater following debridement 25, 29, 31 or irrigation and debridement 3,4,5,12,19,23,24,26,27,30 of the wound. Only one study reported the use of a non-mechanical debridement method 31 .…”

“…Surgical site infection (SSI) 1 and pre-operative radiotherapy 2 are the overwhelming causes of morbidity in post-operative spinal wound complications. SSI rates range from 0.4% to 20% following spinal surgery 1, [3][4][5] . Post-operative incontinence, posterior surgical approach and surgery for tumour resection are additional risk factors for SSI in spinal surgery 6 .…”

“…Early detection of spinal wound complication is the key to preventing superficial infection from becoming deep infection 1 . Negative pressure wound therapy (NPWT) has been reported as a successful measure to aid closure 4,5,12 in patients with a spinal wound and may advance wound healing and prevent infection.…”

“…Jones et al (2007) 3 reported the use of saline containing bacitracin to irrigate the wound. The length of time for NPWT in situ ranged from 3 to 186 days and was provided by 5 studies 4,23,24,26,30 .…”

“…Three studies 3,4,19 reported the average length of stay in hospital (range 14 to 43 days). It is interesting to note that effective use of NPWT has been reported in patients with pyoderma gangrenosum even though there is a theoretical risk of an exaggerated inflammatory response 32 .…”