Elsevier

The Spine Journal

Volume 13, Issue 10, October 2013, Pages 1393-1405
The Spine Journal

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

https://doi.org/10.1016/j.spinee.2013.06.040Get rights and content

Abstract

Background context

The management of postoperative spinal wound complication remains a challenge, with surgical site infection (SSI) incidence rates ranging from 0.4% to 20% after spinal surgery. Negative pressure wound therapy (NPWT) has been highlighted as an intervention that may stimulate healing and prevent SSI. However, the wound healing mechanism by NPWT and its effectiveness in spinal wounds still remain unclear.

Purpose

To systematically search, critically appraise, and summarize randomized controlled trials (RCTs) and non-RCTs assessing the effectiveness of NPWT in patients with a spinal wound.

Study design

Systematic review.

Methods

A systematic review based on search strategies recommended by the Cochrane Back and Wounds Review Groups was undertaken using Cochrane Library, MEDLINE, EMBASE, and CINAHL databases. Any publications between 1950 and 2011 were included. Funding to undertake the review was received from the University of Huddersfield Collaborative Venture Fund ($4,820) and KCI Medical ($4,820).

Results

Ten retrospective studies and four case studies of patients with spinal wound complication were included in this systematic review. No RCTs were found. Only one study described more than 50 patients. Generally, a pressure of −125 mm Hg was used in adults. Duration of NPWT in situ ranged from 3 to 186 days. Wound healing was assessed every 2 to 3 days and generally completed between 7 days and 16 months. Negative pressure wound therapy is contraindicated in the presence of active cerebrospinal fluid leak, metastatic or neoplastic disease in the wound or in patients with an allergy to the NPWT dressing and in those with a bleeding diathesis.

Conclusions

Published reports are limited to small retrospective and case studies, with no reports of NPWT being used as a prophylactic treatment. Larger prospective RCTs of NPWT are needed to support the current evidence that it is effective in treating spinal wound complications. In addition, future studies should investigate its use as a prophylactic treatment to prevent infection and report data relating to safety and health economics.

Section snippets

Description of the condition

The management of postoperative spinal wound complication remains a significant challenge. Surgical site infection (SSI) [1] and preoperative radiotherapy [2] are the overwhelming causes of morbidity in postoperative spinal wound complications. Surgical site infection rates range from 0.4% to 20% after spinal surgery [1], [3], [4], [5]. Postoperative incontinence, posterior surgical approach, and surgery for tumor resection are additional risk factors for SSI in spinal surgery [6].

Prophylactic

Types of studies

We sought all relevant RCTs or quasi-methods of participant allocation. Studies that compared NPWT versus pharmacological interventions (eg, antibiotics) and physical interventions (eg, irrigation, gauze/hydrocolloid regimen) were eligible for this review.

We also sought all other NPWT studies (case studies and retrospective studies) to evaluate the potential benefits and risks of NPWT in patients with a spinal wound.

Type of participants

This review includes any types of patient in any health care setting with a

Selection of studies

Reviewers read all titles and abstracts resulting from the search process and eliminated any studies that were not relevant for this review. Full copies of all potentially relevant studies were obtained. All reviewers acted independently to classify these as include or exclude studies. Any discrepancy about the relevance and design of the studies between the reviewers was resolved by discussion and the decision to include the studies was based on the inclusion criteria. The reviewers sought

Results

Searching the different databases for this review yielded 232 publications: 89 publications from MEDLINE, 123 publications from EMBASE, 17 publications from CINAHL, and three publications from hand-searched journals. After removing the duplicates, of which 209 did not meet the inclusion criteria, 23 publications were retrieved in full, of which nine were excluded because they were not individual studies focusing on NPWT and spinal wounds; five were literature reviews and four were not primarily

Discussion

The NPWT technique has been used with the intention of improving wound healing in patients undergoing spinal surgery. However, this review reveals no RCTs that have been undertaken to assess the clinical effectiveness of NPWT after spinal surgery. Furthermore, the majority of published reports describe the use of the technique to treat SSI, with none formally investigating its potential to stimulate wound healing and prevent infection.

Two recent prospective RCTs investigating immediate use of

Acknowledgments

The authors thank Anna Fletcher and Linda Upton (Spinal Unit, Salford Royal NHS Foundation Trust) for their support.

References (55)

  • M.A. van Rhee et al.

    Vacuum-assisted wound closure of deep infections after instrumented spinal fusion in six children with neuromuscular scoliosis

    Spine J

    (2007)
  • S.K. Mithani et al.

    Management of wound complications in spinal surgery

    Contemporary Spine Surgery

    (2008)
  • Z. Ghogawala et al.

    Spinal radiation before surgical decompression adversely affects outcomes of surgery for symptomatic metastatic spinal cord compression

    Spine (Phila Pa 1976)

    (2001)
  • G.A. Jones et al.

    Negative-pressure wound therapy in the treatment of complex postoperative spinal wound infections: complications and lessons learned using vacuum-assisted closure

    J Neurosurg Spine

    (2007)
  • L. Labler et al.

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

    Eur Spine J

    (2006)
  • A.A. Mehbod et al.

    Postoperative deep wound infections in adults after spinal fusion: management with vacuum-assisted wound closure

    J Spinal Disord Tech

    (2005)
  • M.A. Olsen et al.

    Risk factors for surgical site infection in spinal surgery

    J Neurosurg

    (2003)
  • F.G. Barker

    Efficacy of prophylactic antibiotic therapy in spinal injury: met-analysis

    Neurosugery

    (2002)
  • D.H. Payne et al.

    Efficacy of closed wound suction drainage after single-level lumbar laminectomy

    J Spinal Disord

    (1996)
  • G.J. Scuderi et al.

    Is wound drainage necessary after lumbar spinal fusion surgery?

    Med Sci Monit

    (2005)
  • M.D. Brown et al.

    A randomized study of closed wound suction drainage for extensive lumbar spine surgery

    Spine (Phila Pa 1976)

    (2004)
  • M.T. Cheng et al.

    Efficacy of dilute betadine solution irrigation in the prevention of postoperative infection of spinal surgery

    Spine (Phila Pa 1976)

    (2005)
  • M.J. Yuan-Innes et al.

    Vacuum-assisted wound closure: a new approach to spinal wounds with exposed hardware

    Spine (Phila Pa 1976)

    (2001)
  • Dersch T, Morykwas M, Clark M, Argenta L. Effects of negative and positive pressure on skin oxygen tension and...
  • D.A. Mendonca et al.

    Negative-pressure wound therapy: a snapshot of the evidence

    Int Wound J

    (2006)
  • L.C. Argenta et al.

    Vacuum-assisted closure: a new method for wound control and treatment: clinical experience

    Ann Plast Surg

    (1997)
  • D.T. Ubbink et al.

    Topical negative pressure for treating chronic wounds

    Cochrane Database Syst Rev

    (2008)
  • C.M. Plikaitis et al.

    Subatmospheric pressure wound therapy and the vacuum-assisted closure device: basic science and current clinical successes

    Expert Rev Med Devices

    (2006)
  • M.J. Morykwas et al.

    Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation

    Ann Plast Surg

    (1997)
  • A. Ploumis et al.

    Therapy of spinal wound infections using vacuum-assisted wound closure: risk factors leading to resistance to treatment

    J Spinal Disord Tech

    (2008)
  • D.P. Nicolau

    Current challenges in the management of the infected patient

    Curr Opin Infect Dis

    (2011)
  • A.D. Furlan et al.

    2009 Updated method guidelines for systematic reviews in the Cochrane Back Review Group

    Spine (Phila Pa 1976)

    (2009)
  • M. Dixon-Woods et al.

    Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups

    BMC Med Res Methodol

    (2006)
  • S.W. Zehnder et al.

    Vacuum-assisted wound closure in postoperative spinal wound infection

    Orthopedics

    (2007)
  • S. Antony et al.

    A retrospective study: clinical experience using vacuum-assisted closure in the treatment of wounds

    J Natl Med Assoc

    (2004)
  • F. Canavese et al.

    Vacuum-assisted closure for deep infection after spinal instrumentation for scoliosis

    J Bone Joint Surg Br

    (2008)
  • F. Canavese et al.

    Use of the vacuum assisted closure in instrumented spinal deformities for children with neuromuscular scoliosis who developed post-operative deep spinal infection

    Dev Med Child Neurol

    (2009)
  • Cited by (56)

    • Current Management Trends for Surgical Site Infection After Posterior Lumbar Spinal Instrumentation: A Systematic Review

      2022, World Neurosurgery
      Citation Excerpt :

      The incidence of surgical site infections (SSIs) after instrumented spinal operations ranges from 2%–20%.1,2

    View all citing articles on Scopus

    FDA device/drug status: Not applicable.

    Author disclosures: KJO: Grants: KCI Medical (B, Paid directly to institution), University of Huddersfield (B, Paid directly to institution). RAA: Support for travel to meetings for the study or other purposes: KCI Medical (A, Paid directly to institution); Payment for writing or reviewing the manuscript: University of Huddersfield (B, Paid directly to institution). JBW: Nothing to disclose. SL: Grants: KCI Medical (B, Paid directly to institution), University of Huddersfield (B, Paid directly to institution).

    The disclosure key can be found on the Table of Contents and at www.TheSpineJournalOnline.com.

    Funding to undertake the review was received from the University of Huddersfield Collaborative Venture Fund and KCI Medical. No other conflict of interest is declared.

    View full text