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.
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Abbey DM, Turner DM, Warson JS, Wirt TC, Scalley RD (1995) Treatment of postoperative wound infections following spinal fusion with instrumentation. J Spinal Disord 8:278–283
Arens S, Schlegel U, Printzen G, Ziegler WJ, Perren SM, Hansis M (1996) Influence of materials for fixation implants on local infection. An experimental study of steel versus titanium DCP in rabbits. J Bone Joint Surg Br 78:647–651
Argenta LC, Morykwas MJ (1997) Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg 38:563–576
Aydinli U, Karaeminogullari O, Tiskaya K (1999) Postoperative deep wound infection in instrumented spinal surgery. Acta Orthop Belg 65:182–187
Baker SP, O’Neill B, Haddon W Jr, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196
Bernard L, Hoffmeyer P, Assal M, Vaudaux P, Schrenzel J, Lew D (2004) Trends in the treatment of orthopaedic prosthetic infections. J Antimicrob Chemother 53:127–129
Calderone RR, Garland DE, Capen DA, Oster H (1996) Cost of medical care for postoperative spinal infections. Orthop Clin North Am 27:171–182
Carragee EJ (1997) Instrumentation of the infected and unstable spine: a review of 17 cases from the thoracic and lumbar spine with pyogenic infections. J Spinal Disord 10:317–324
Casas LA, Lewis VL Jr (1989) A reliable approach to the closure of large acquired midline defects of the back. Plast Reconstr Surg 84:632–641
Costerton JW (2005) Biofilm theory can guide the treatment of device-related orthopaedic infections. Clin Orthop Relat Res 437:7–11
Davne SH, Myers DL (1992) Complications of lumbar spinal fusion with transpedicular instrumentation. Spine 17:S184–S189
Dernbach PD, Gomez H, Hahn J (1990) Primary closure of infected spinal wounds. Neurosurgery 26:707–709
Dietze DD Jr, Fessler RG, Jacob RP (1997) Primary reconstruction for spinal infections. J Neurosurg 86:981–989
Disa JJ, Smith AW, Bilsky MH (2001) Management of radiated reoperative wounds of the cervicothoracic spine: the role of the trapezius turnover flap. Ann Plast Surg 47:394–397
Dumanian GA, Ondra SL, Liu J, Schafer MF, Chao JD (2003) Muscle flap salvage of spine wounds with soft tissue defects or infection. Spine 28:1203–1211
Dunne WM Jr (2002) Bacterial adhesion: seen any good biofilms lately? Clin Microbiol Rev 15:155–166
Esses SI, Sachs BL, Dreyzin V (1993) Complications associated with the technique of pedicle screw fixation. A selected survey of ABS members. Spine 18:2231–2238
Evans GR, Reece GP (1995) Lower back reconstruction: an approach to wound closure in the cancer patient. Plast Reconstr Surg 96:635–642
Fabian TS, Kaufman HJ, Lett ED, Thomas JB, Rawl DK, Lewis PL, Summitt JB, Merryman JI, Schaeffer TD, Sargent LA, Burns RP (2000) The evaluation of subatmospheric pressure and hyperbaric oxygen in ischemic full-thickness wound healing. Am Surg 66:1136–1143
Falanga V (1992) Growth factors and chronic wounds: the need to understand the microenvironment. J Dermatol 19:667–672
Faraj AA, Webb JK (2000) Spinal instrumentation for primary pyogenic infection report of 31 patients. Acta Orthop Belg 66:242–247
Fleischmann W, Strecker W, Bombelli M, Kinzl L (1993) Vacuum sealing as treatment of soft tissue damage in open fractures. Unfallchirurg 96:488–492
Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH, Vernon JD, Walsh JJ (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I. Paraplegia 7:179–192
Glassman SD, Dimar JR, Puno RM, Johnson JR (1996) Salvage of instrumental lumbar fusions complicated by surgical wound infection. Spine 21:2163–2169
Greer S, Kasabian A, Thorne C, Borud L, Sims CD, Hsu M (1998) The use of a subatmospheric pressure dressing to salvage a Gustilo grade IIIB open tibial fracture with concomitant osteomyelitis to avert a free flap. Ann Plast Surg 41:687
Hanssen AD, Spangehl MJ (2004) Treatment of the infected hip replacement. Clin Orthop Relat Res 420:63–71
Hochberg J, Ardenghy M, Yuen J, Gonzalez-Cruz R, Miura Y, Conrado RM, Pait TG (1998) Muscle and musculocutaneous flap coverage of exposed spinal fusion devices. Plast Reconstr Surg 102:385–389
Hofmann GO, Bar T, Buhren V (1997) The osteosynthesis implant and early postoperative infection: healing with or without removal of the material? Chirurg 68:1175–1180
Ido K, Shimizu K, Nakayama Y, Shikata J, Matsushita M, Nakamura T (1996) Suction/irrigation for deep wound infection after spinal instrumentation a: case study. Eur Spine J 5:345–349
Klein JD, Garfin SR (1996) Nutritional status in the patient with spinal infection. Orthop Clin North Am 27:33–36
Klekamp J, Spengler DM, McNamara MJ, Haas DW (1999) Risk factors associated with methicillin-resistant staphylococcal wound infection after spinal surgery. J Spinal Disord 12:187–191
Klink BK, Thurman RT, Wittpenn GP, Lauerman WC, Cain JE (1994) Muscle flap closure for salvage of complex back wounds. Spine 19:1467–1470
Labbe AC, Demers AM, Rodrigues R, Arlet V, Tanguay K, Moore DL (2003) Surgical-site infection following spinal fusion: a case-control study in a children’s hospital. Infect Control Hosp Epidemiol 24:591–595
Labler L, Keel M, Trentz O (2004) New application of V.A.C. (vacuum assisted closure) in the abdominal cavity in case of open abdomen therapy. Zentralbl Chir 129:S14–S19
Labler L, Keel M, Trentz O (2004) Vacuum assisted closure (V.A.C.) for temporary coverage of soft tissue injury in type III open fracture of lower extremities. Eur J Trauma 30:305–312
Labler L, Oehy K (2000) Vacuum sealing of problem wounds. Swiss Surg 8:266–272
Labler L, Zwingmann J, Mayer D, Stocker R, Trentz O, Keel M (2005) V.A.C. abdominal dressing system: a temporary closure for open abdomen. Eur J Trauma 31:488–494
Ladin D, Rees R, Wilkins E, Sondak V, McGillicuddy J (1993) The use of omental transposition in the treatment of recurrent sarcoma of the back. Ann Plast Surg 31:556–559
Levi AD, Dickman CA, Sonntag VK (1997) Management of postoperative infections after spinal instrumentation. J Neurosurg 86:975–980
Malamo-Lada H, Zarkotou O, Nikolaides N, Kanellopoulou M, Demetriades D (1999) Wound infections following posterior spinal instrumentation for paralytic scoliosis. Clin Microbiol Infect 5:135–139
Manstein ME, Manstein CH, Manstein G (1998) Paraspinous muscle flaps. Ann Plast Surg 40:458–462
Massie JB, Heller JG, Abitbol JJ, McPherson D, Garfin SR (1992) Postoperative posterior spinal wound infections. Clin Orthop Relat Res 284:99–108
Maynard FM Jr, Bracken MB, Creasey G, Ditunno JF Jr, Donovan WH, Ducker TB, Garber SL, Marino RJ, Stover SL, Tator CH, Waters RL, Wilberger JE, Young W (1997) International standards for neurological and functional classification of spinal cord injury. American spinal injury association. Spinal Cord 35:266–274
Mehbod AA, Ogilvie JW, Pinto MR, Schwender JD, Transfeldt EE, Wood KB, Le Huec JC, Dressel T (2005) Postoperative deep wound infections in adults after spinal fusion: management with vacuum-assisted wound closure. J Spinal Disord Tech 18:14–17
Meiners T, Flieger R, Jungclaus M (2003) Use of the reverse latissimus muscle flap for closure of complex back wounds in patients with spinal cord injury. Spine 28:1893–1898
Mitra A, Mitra A, Harlin S (2004) Treatment of massive thoracolumbar wounds and vertebral osteomyelitis following scoliosis surgery. Plast Reconstr Surg 113:206–213
Mooney JF 3rd, Argenta LC, Marks MW, Morykwas MJ, DeFranzo AJ (2000) Treatment of soft tissue defects in pediatric patients using the V.A.C. system. Clin Orthop Relat Res 376:26–31
Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W (1997) Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 38:553–562
Moues CM, Vos MC, van den Bemd GJ, Stijnen T, Hovius SE (2004) Bacterial load in relation to vacuum-assisted closure wound therapy: a prospective randomized trial. Wound Repair Regen 12:11–17
Muschik M, Luck W, Schlenzka D (2004) Implant removal for late-developing infection after instrumented posterior spinal fusion for scoliosis: reinstrumentation reduces loss of correction. A retrospective analysis of 45 cases. Eur Spine J 13:645–651
Perry JW, Montgomerie JZ, Swank S, Gilmore DS, Maeder K (1997) Wound infections following spinal fusion with posterior segmental spinal instrumentation. Clin Infect Dis 24:558–561
Philbeck TE Jr, Whittington KT, Millsap MH, Briones RB, Wight DG, Schroeder WJ (1999) The clinical and cost effectiveness of externally applied negative pressure wound therapy in the treatment of wounds in home healthcare Medicare patients. Ostomy Wound Manage 45:41–50
Picada R, Winter RB, Lonstein JE, Denis F, Pinto MR, Smith MD, Perra JH (2000) Postoperative deep wound infection in adults after posterior lumbosacral spine fusion with instrumentation: incidence and management. J Spinal Disord 13:42–45
Rechtine GR, Bono PL, Cahill D, Bolesta MJ, Chrin AM (2001) Postoperative wound infection after instrumentation of thoracic and lumbar fractures. J Orthop Trauma 15:566–569
Richards BR, Emara KM (2001) Delayed infections after posterior TSRH spinal instrumentation for idiopathic scoliosis: revisited. Spine 26:1990–1996
Richards BS (1995) Delayed infections following posterior spinal instrumentation for the treatment of idiopathic scoliosis. J Bone Joint Surg Am 77:524–529
Roberts FJ, Walsh A, Wing P, Dvorak M, Schweigel J (1998) The influence of surveillance methods on surgical wound infection rates in a tertiary care spinal surgery service. Spine 23:366–370
Soultanis K, Mantelos G, Pagiatakis A, Soucacos PN (2003) Late infection in patients with scoliosis treated with spinal instrumentation. Clin Orthop Relat Res 411:116–123
Sponseller PD, LaPorte DM, Hungerford MW, Eck K, Bridwell KH, Lenke LG (2000) Deep wound infections after neuromuscular scoliosis surgery: a multicenter study of risk factors and treatment outcomes. Spine 25:2461–2466
Stambough JL, Beringer D (1992) Postoperative wound infections complicating adult spine surgery. J Spinal Disord 5:277–285
Thalgott JS, Cotler HB, Sasso RC, LaRocca H, Gardner V (1991) Postoperative infections in spinal implants. Classification and analysis—a multicenter study. Spine 16:981–984
Viola RW, King HA, Adler SM, Wilson CB (1997) Delayed infection after elective spinal instrumentation and fusion. A retrospective analysis of eight cases. Spine 22:2444–2450
Vitaz TW, Oishi M, Welch WC, Gerszten PC, Disa JJ, Bilsky MH (2004) Rotational and transpositional flaps for the treatment of spinal wound dehiscence and infections in patient populations with degenerative and oncological disease. J Neurosurg 100:46–51
Weed T, Ratliff C, Drake DB (2004) Quantifying bacterial bioburden during negative pressure wound therapy: does the wound VAC enhance bacterial clearance? Ann Plast Surg 52:276–279
Weinstein MA, McCabe JP, Cammisa FP Jr (2000) Postoperative spinal wound infection: a review of 2,391 consecutive index procedures. J Spinal Disord 13:422–426
Wendt JR, Gardner VO, White JI (1998) Treatment of complex postoperative lumbosacral wounds in nonparalyzed patients. Plast Reconstr Surg 101:1248–1253
Wilhelmi BJ, Snyder N, Colquhoun T, Hadjipavlou A, Phillips LG (2000) Bipedicle paraspinous muscle flaps for spinal wound closure: an anatomic and clinical study. Plast Reconstr Surg 106:1305–1311
Wimmer C, Gluch H (1996) Management of postoperative wound infection in posterior spinal fusion with instrumentation. J Spinal Disord 9:505–508
Wimmer C, Gluch H, Franzreb M, Ogon M (1998) Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures. J Spinal Disord 11:124–128
Yuan-Innes MJ, Temple CL, Lacey MS (2001) Vacuum-assisted wound closure: a new approach to spinal wounds with exposed hardware. Spine 26:E30–E33
Zimmerli W, Ochsner PE (2003) Management of infection associated with prosthetic joints. Infection 31:99–108
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Labler, L., Keel, M., Trentz, O. et al. Wound conditioning by vacuum assisted closure (V.A.C.) in postoperative infections after dorsal spine surgery. Eur Spine J 15, 1388–1396 (2006). https://doi.org/10.1007/s00586-006-0164-2
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DOI: https://doi.org/10.1007/s00586-006-0164-2