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

Restricted access

Object

Deep infections of the spine are a significant cause of morbidity and death. Such infections complicate 0.7 to 11.9% of spinal procedures. Management includes intravenous antibiotic therapy, debridement and irrigation with primary closure, placement of drains, use of irrigation systems, and/or healing through secondary intention with wound packing. Vacuum-assisted closure (VAC) is a new alternative for treatment of patients with complex postoperative spinal infections. The aim of this study was to investigate the safety of this treatment method in this patient population.

Methods

The authors reviewed the charts of 16 consecutive patients treated with negative-pressure wound therapy at their institution between 2002 and 2006. All had deep infections of the spine and were treated with surgical debridement and placement of VAC dressings. All infections were postoperative. Members of the infectious disease service were involved in the care of all patients, and all patients received intravenous antibiotic therapy. The authors reviewed operative notes, discharge summaries, and notes from follow-up visits and assessed outcome on the basis of the same records.

Three patients were lost to follow up, leaving a group of 13 with follow up of at least 90 days. Two patients experienced bleeding complications related to the continuous negative pressure of the VAC device. In two cases, the infections persisted and required reoperation. In one case, a skin graft was required because of nonhealing granulation tissue. One of the patients with bleeding complications died as a result of delayed complications related to intraoperative blood loss, blood loss via the VAC system, and refusal of a blood transfusion on religious grounds.

Conclusions

Negative-pressure wound therapy has been employed as a treatment strategy for patients with complex postoperative spinal infections, but little is known of the complications associated with VAC in the spinal surgery patient population. Serious complications, including death, may be associated with use of the VAC system.

Abbreviations used in this paper:PICC = peripherally introduced central catheter; VAC = vacuum-assisted closure.

Article Information

Address reprint requests to: Richard Schlenk, M.D., Cleveland Clinic Spine Institute, Mail Code S-80, 9500 Euclid Avenue, Cleveland, Ohio 44195. email: schlenr@ccf.org.

© AANS, except where prohibited by US copyright law.

Headings

References

1

Argenta LCMorykwas MJ: Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plastic Surg 38:5635771997

2

Banwell PE: Topical negative pressure therapy in wound care. J Wound Care 8:79841999

3

Beiner JMGrauer JKwon BKVaccaro AR: Postoperative wound infections of the spine. Neurosurg Focus 15:3E142003

4

Calderone RRGarland DECapen DAOster H: Cost of medical care for postoperative spinal infections. Orthop Clin North Am 27:1711821996

5

DeFranzo AJArgenta LCMarks MWMolnar JADavid LRWebb LX: The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone. Plastic Reconstr Surg 108:118411912001

6

Fox ATadros APerks AG: An unusual complication of vacuum-assisted closure in the treatment of a pressure ulcer. J Wound Care 13:3443452004

7

Friedman TWestreich MShalom A: Vacuum-assisted closure treatment complicated by anasarca. Ann Plast Surg 55:4204212005

8

Fuchs UZittermann AStuettgen BGroening AMinami KKoerfer R: Clinical outcome of patients with deep sternal wound infection managed by vacuum-assisted closure compared to conventional therapy with open packing: a retrospective analysis. Ann Thorac Surg 79:5265312005

9

Gwan-Nulla DNCasal RS: Toxic shock syndrome associated with the use of the vacuum-assisted closure device. Ann Plast Surg 47:5525542001

10

Labler LKeel MTrentz OHeinzelmann M: Wound conditioning by vacuum assisted closure (V.A.C.) in postoperative infections after dorsal spine surgery. Eur Spine J 15:138813962006

11

Mehbod AAOgilvie JWPinto MRSchwender JDTransfeldt EEWood KB: Postoperative deep wound infections in adults after spinal fusion: management with vacuum-assisted wound closure. J Spinal Disord Tech 18:14172005

12

Morykwas MJArgenta LCShelton-Brown EIMcGuirt W: Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plastic Surg 38:5535621997

13

Moues CMVos MCVan Den Bemd GJStijnen THovius SE: Bacterial load in relation to vacuum-assisted closure wound therapy: a prospective randomized trial. Wound Repair Regen 12:11172004

14

National Nosocomial Infections Surveillance (NNIS) System: National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 32:4704852004

15

Nugent NLannon DO'Donnell M: Vacuum-assisted closure—a management option for the burns patient with exposed bone. Burns 31:3903932005

16

Roberts FJWalsh AWing PDvorak MSchweigel J: The influence of surveillance methods on surgical wound infection rates in a tertiary care spinal surgery service. Spine 23:3663701998

17

Saxena VHwang CWHuang SEichbaum QIngber D: Vacuum-assisted closure: microdeformations of wounds and cell proliferation. Plast Reconstr Surg 114:108610962004

18

Sjogren JGustafsson RNilsson JMalmsjo MIngemansson R: Clinical outcome after poststernotomy mediastinitis: vacuum-assisted closure versus conventional treatment. Ann Thorac Surg 79:204920552005

19

Venturi MLAttinger CEMesbahi ANHess CLGraq KS: Mechanisms and clinical applications of the vacuum-assisted closure (VAC) device. Am J Clin Dermatol 6:1851942005

20

White RAMiki RAKazmier PAnglen JO: Vacuum-assisted closure complicated by erosion and hemorrhage of the anterior tibial artery. J Orthop Trauma 19:56592005

21

Yuan-Innes MJTemple CLLacey MS: Vacuum-assisted wound closure: a new approach to spinal wounds with exposed hardware. Spine 26:E30E332001

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 59 59 15
Full Text Views 44 44 13
PDF Downloads 87 87 14
EPUB Downloads 0 0 0

PubMed

Google Scholar