APPLICATION OF NEGATIVE PRESSURE WOUND THERAPY IN THE TREATMENT OF PYOINFLAMMATORY COMPLICATIONS AFTER SPINAL SURGERY

Objective. To analyze the first experience of negative pressure wound therapy in the treatment of patients with infectious complications after surgical interventions on the spine.

Material and Methods. Clinical cases of negative pressure wound therapy (NPWT) in patients with peri-implant infection developed after decompression and stabilization interventions for degenerative disease (n = 2), and injury (n = 1) of the spine are presented.

b. Good results were achieved in all three patients. Average length of hospital stay was 33 days. Implants were successfully preserved in two patients. The average time of wound closure before cutaneous suturing was 10.3 days.

Conclusions. The use of NPWT objectively reduces the number of surgical debridements and shortens drainage and healing of the wound. 

1. Ульрих Э.В., Мушкин А.Ю. Вертебрология в терминах, цифрах, рисунках. СПб., 2004.

2. Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997;38:563-577.

3. Beiner JM, Grauer J, Kwon BK, Vaccaro AR. Postoperative wound infections of the spine. Neurosurg Focus. 2003;15:E14.

4. Blam OG, Vaccaro AR, Vanichkachorn JS, Albert TJ, Hilibrand AS, Minnich JM, Murphey SA. Risk factors for surgical site infection in the patient with spinal injury. Spine. 2003;28:1475-1480.

5. Calderone RR, Garland DE, Caper DA, Oster H. Cost of medical care for postoperative spinal infections. Orthop Clin North Am. 1996;27:171-182.

6. Cammisa FP Jr, Girardi FP, Sangani PK, Parvataneni HK, Cadag S, Sandhu HS. Incidental durotomy in spine surgery. Spine. 2000;25:2663-2667.

7. Capen DA, Calderone RR, Green A. Perioperative risk factors for wound infections after lower back fusions. Orthop Clin North Am. 1996;27:83-86.

8. Chang CW, Chan HZ, Lim SW, Khoo EH, Zulkiflee O. Negative pressure wound therapy in infected wound following posterior spinal instrumentation using simple self-assembled system: a case report. Malays Orthop J. 2014;8:49-51. DOI: 10.5704/MOJ.1407.004.

9. Fang A, Hu SS, Endres N, Bradford DS. Risk factors for infection after spinal surgery. Spine. 2005;30:1460-1465. DOI: 10.1097/01.brs.0000166532.58227.4f.

10. Friedman ND, Sexton DJ, Connelly SM, Kaye KS. Risk factors for surgical site infection complicating laminectomy. Infect Control Hosp Epidemiol. 2007;28:1060-1065. DOI: 10.1086/519864.

11. Hegde V, Meredith DS, Kepler CK, Huang RC. Management of postoperative spinal infections. World J Orthop. 2012;3:182-189. DOI: 10.5312/wjo.v3.i11.182.

12. Jones GA, Butler J, Lieberman I, Schlenk R. 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;6:407-411. DOI: 10.3171/spi.2007.6.5.407.

13. Kang BU, Lee SH, Ahn Y, Choi WC, Choi YG. Surgical site infection in spinal surgery: detection and management based on serial C-reactive protein measurements. J Neurosurg Spine. 2010;13:158-164. DOI: 10.3171/2010.3.SPINE09403.

14. Karaaslan F, Erdem S, Mermerkaya MU. Wound management with vacuum-assisted closure in postoperative infections after surgery for spinal stenosis. Int Med Case Rep J. 2015;8:7-11. DOI: 10.2147/IMCRJ.S76214.

15. Karlakki S, Brem M, Giannini S, Khanduja V, Stannard J, Martin R. Negative pressure wound therapy for management of the surgical incision in orthopaedic surgery: A review of evidence and mechanisms for an emerging indication. Bone Joint Res. 2013;2:276-284. DOI: 10.1302/2046-3758.212.2000190.

16. Koutsoumbelis S, Hughes AP, Girardi FP, Cammisa FP Jr, Finerty EA, Nguyen JT, Gausden E, Sama AA. Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis. J Bone Joint Surg Am. 2011;93:1627-1633. DOI: 10.2106/JBJS.J.00039.

17. Labler L, Keel M, Trentz O, Heinzelmann M. Wound conditioning by vacuum assisted closure (V.A.C.) in postoperative infections after dorsal spine surgery. Eur Spine J. 2006;15:1388-1396. DOI: 10.1007/s00586-006-0164-2.

18. Lehner B, Fleischmann W, Becker R, Jukema GN. First experiences with negative pressure wound therapy and instillation in the treatment of infected orthopedic implants: a clinical observational study. Int Orthop. 2011;35:1415-1420. DOI: 10.1007/s00264-011-1274-y.

19. Malone DL, Genuit T, Tracy JK, Gannon C, Napolitano LM. Surgical site infections: reanalysis of risk factors. J Surg Res. 2002;103:89-95. DOI: 10.1006/jsre.2001.634.3.

20. Massie JB, Heller JG, Abitbol JJ, McPherson D, Garfin SR. Postoperative posterior spinal wound infections. Clin Orthop Relat Res. 1992;(284):99-108. DOI: 10.1097/00003086-199211000-00013.

21. Nordmeyer M, Pauser J, Biber R, Jantsch, Lehrl S, Kopschina C, Rapke C, Bail HJ, Forst R, Brem MH. Negative pressure wound therapy for seroma prevention and surgical incision treatment in spinal fracture care. Int Wound J. 2016;13:1176-1179. DOI: 10.1111/iwj.12436.

22. Ousey KJ, Atkinson RA, Williamson JB, Lui S. Negative pressure wound therapy (NPWT) for spinal wounds: a systematic review. Spine J. 2013;13:1393-1405. DOI: 10.1016/j.spinee.

23. Pachowsky M, Gusinde J, Klein A, Lehrl S, Schulz-Drost S, Schlechtweg P, Pauser J, Gelse K, Brem MH. Negative pressure wound therapy to prevent seromas and treat surgical incisions after total hip arthroplasty. Int Orthop. 2012;36;719-722. DOI: 10.1007/s00264-011-1321-8.

24. Ploumis A, Mehbod AA, Dressel TD, Dykes DC, Transfeldt EE, Lonstein JE. Therapy of spinal wound infection using vacuum-assisted wound closure: risk factors leading to resistance to treatment. J Spinal Disord Tech. 2008;21:320-323. DOI: 10.1097/BSD.0b013e318141f99d.

25. Pull ter Gunne AF, Cohen DB. Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery. Spine. 2009;34:1422-1428. DOI: 10.1097/BRS.0b013e3181a03013.

26. Stannard JP, Robinson JT, Anderson ER, McGwin G Jr, Volgas DA, Alonso JE. Negative pressure wound therapy to treat hematomas and surgical incisions following high-energy trauma. J Trauma. 2006;60:1301-1306. DOI: 10.1097/01.ta.0000195996.73186.2e.

27. Techtine GR, Bono PL, Cahill D, Bolesta MJ, Chrin AM. Postoperative wound infection after instrumentation of thoracic and lumbar fractures. J Orthop Trauma. 2001;15:566-569.

28. Topkoru B, Kaner T. Negative pressure wound therapy (VAC®) for the treatment of spinal surgical site infections. World Spinal Column Journal. 2015;6:46-49.

29. Van Goethem JW, Parizel PM, Jinkins JR. Review article: MRI of the postoperative lumbar spine. Neuroradiology. 2002;44:723-739. DOI: 10.1007/s00234-002-0790-2.

30. Vicario C, de Juan J, Esclarin A, Alcobendas M. Treatment of deep wound infection after spinal fusion with a vacuum-assisted device in patients with spinal cord injury. Acta Orthop Belg. 2007;73:102-106.

31. Weinstein MA, McCabe JP, Cammisa FP Jr. Postoperative spinal wound infection: a review of 2,391 consecutive procedures. J Spinal Disord. 2000;13:422-426. DOI: 10.1097/00002517-200010000-00009.