Vacuum Sealing Drainage for Early Deep Infection after Posterior Spinal Internal Fixation_West China Medical Journal

Authors：

 XUEJing , SONGYue-ming , LIUHao ,  LITao , MALi-tai

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LITao, Email: litao55@hotmail.com

Keywords：

Spinal; Internal fixation; Infection; Vacuum

DOI：

10.7507/1002-0179.20140207

Video：

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Objective To analyze the curative effect of vacuum sealing drainage for early deep infection after posterior spinal internal fixation. Methods From March 2009 to March 2012, 9 patients with early deep infection after posterior spinal internal fixation, including 5 males and 4 females aged between 21 and 64 years, averaging at 44.6, underwent debridement and vacuum sealing drainage (VSD). Original fixtures in all the patients were not taken out. Results The patients were treated by VSD for once to three times with an average of 2.1 times, and VSD continued for 3 to 7 days every time. Two patients underwent one time of VSD, 4 underwent twice, and 3 underwent three times. In these patients, 6 achieved wound healing after VSD, one changed to ordinary dressing and wound suturing two weeks later due to hemorrhage of VSD, one changed to ordinary dressing and wound suturing wound three weeks later due to impeded drainage, one accepted skin-grafting after three times of VSD. All the patients were followed up for 6 to 38 months (18 months on average) and all of them were cured. There was no obvious back pain or signs of incision infection. The X-ray films showed that there were no bone destruction and the white blood cell count, erythrocyte sedimentation rate, and C-reactive protein significantly decreased to normal after surgery. Conclusion One-stage debridement and vacuum sealing drainage therapy is an effective method for treating early deep infection after posterior spinal internal fixation.

Citation： XUEJing, SONGYue-ming, LIUHao, LITao, MALi-tai. Vacuum Sealing Drainage for Early Deep Infection after Posterior Spinal Internal Fixation. West China Medical Journal, 2014, 29(4): 685-687. doi: 10.7507/1002-0179.20140207 Copy

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5.	Nunes BK, Lacerda RA, Jardim JM. Systematic review and meta-analysis of the predictive value of C-reactive protein in postoperative infections[J]. Rev Esc Enferm USP, 2011, 45(6):1488-1494.
6.	Hong HS, Chang MC, Liu CL, et al. Is aggressive surgery necessary for acute postoperative deep spinal wound infection?[J]. Spine (Phila Pa 1976), 2008, 33(22):2473-2478.
7.	Mirovsky Y, Floman Y, Smorgick Y, et al. Management of deep wound infection after posterior lumbar interbody fusion with cages[J]. J Spinal Disord Tech, 2007, 20(2):127-131.
8.	Soultanis K, Mantelos G, Pagiatakis A, et al. Late infection in patients with scoliosis treated with spinal instrumentation[J]. Clin Orthop Relat Res, 2003(411):116-123.
9.	Sierra-Hoffman M, Jinadatha C, Carpenter JL, et al. Postoperative instrumented spine infections:a retrospective review[J]. South Med J, 2010, 103(1):25-30.
10.	Jones GA, Butler J, Lieberman I, et al. Negative-pressure wound therapy in the treatment of complex postoperative spinal wound infections:complications and lessons learned using vacuum-assisted closure[J]. J Neurosurg Spine, 2007, 6(5):407-411.
11.	Venturi ML, Attinger CE, Mesbahi AN, et al. Mechanisms and clinical applications of the vacuum-assisted closure (VAC) device:a review[J]. Am J Clin Dermatol, 2005, 6(3):185-194.
12.	Defranzo AJ, Argenta LC, Marks MW, et al. The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone[J]. Plast Reconstr Surg, 2001, 108(5):1184-1191.
13.	Fox A, Tadros A, Perks AG. An unusual complication of Vacuum Assisted Closure in the treatment of a pressure ulcer[J]. J Wound Care, 2004, 13(8):344-345.
14.	Gwan-Nulla DN, Casal RS. Toxic shock syndrome associated with the use of the vacuum-assisted closure device[J]. Ann Plast Surg, 2001, 47(5):552-554.
15.	Friedman T, Westreich M, Shalom A. Vacuum-assisted closure treatment complicated by anasarca[J]. Ann Plast Surg, 2005, 55(4):420-421.
16.	Labler L, Keel M, Trentz O, et al. Wound conditioning by vacuum assisted closure (V.A.C.) in postoperative infections after dorsal spine surgery[J]. Eur Spine J, 2006, 15(9):1388-1396.

1. Wimmer C, Gluch H. Management of postoperative wound infection in posterior spinal fusion with instrumentation[J]. J Spinal Disord, 1996, 9(6):505-508.
2. Beiner JM, Grauer J, Kwon BK, et al. Postoperative wound infections of the spine[J]. Neurosurg Focus, 2003, 15(3):E14.
3. Kim KW, Ha KY, Kim MS, et al. Postoperative trichosporon asahii spondylodiscitis after open lumbar discectomy:a case report[J]. Spine (Phila Pa 1976), 2008, 33(4):E116-E120.
4. Kang BU, Lee SH, Ahn Y, et al. Surgical site infection in spinal surgery:detection and management based on serial C-reactive protein measurements[J]. J Neurosurg Spine, 2010, 13(2):158-164.
5. Nunes BK, Lacerda RA, Jardim JM. Systematic review and meta-analysis of the predictive value of C-reactive protein in postoperative infections[J]. Rev Esc Enferm USP, 2011, 45(6):1488-1494.
6. Hong HS, Chang MC, Liu CL, et al. Is aggressive surgery necessary for acute postoperative deep spinal wound infection?[J]. Spine (Phila Pa 1976), 2008, 33(22):2473-2478.
7. Mirovsky Y, Floman Y, Smorgick Y, et al. Management of deep wound infection after posterior lumbar interbody fusion with cages[J]. J Spinal Disord Tech, 2007, 20(2):127-131.
8. Soultanis K, Mantelos G, Pagiatakis A, et al. Late infection in patients with scoliosis treated with spinal instrumentation[J]. Clin Orthop Relat Res, 2003(411):116-123.
9. Sierra-Hoffman M, Jinadatha C, Carpenter JL, et al. Postoperative instrumented spine infections:a retrospective review[J]. South Med J, 2010, 103(1):25-30.
10. Jones GA, Butler J, Lieberman I, et al. Negative-pressure wound therapy in the treatment of complex postoperative spinal wound infections:complications and lessons learned using vacuum-assisted closure[J]. J Neurosurg Spine, 2007, 6(5):407-411.
11. Venturi ML, Attinger CE, Mesbahi AN, et al. Mechanisms and clinical applications of the vacuum-assisted closure (VAC) device:a review[J]. Am J Clin Dermatol, 2005, 6(3):185-194.
12. Defranzo AJ, Argenta LC, Marks MW, et al. The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone[J]. Plast Reconstr Surg, 2001, 108(5):1184-1191.
13. Fox A, Tadros A, Perks AG. An unusual complication of Vacuum Assisted Closure in the treatment of a pressure ulcer[J]. J Wound Care, 2004, 13(8):344-345.
14. Gwan-Nulla DN, Casal RS. Toxic shock syndrome associated with the use of the vacuum-assisted closure device[J]. Ann Plast Surg, 2001, 47(5):552-554.
15. Friedman T, Westreich M, Shalom A. Vacuum-assisted closure treatment complicated by anasarca[J]. Ann Plast Surg, 2005, 55(4):420-421.
16. Labler L, Keel M, Trentz O, et al. Wound conditioning by vacuum assisted closure (V.A.C.) in postoperative infections after dorsal spine surgery[J]. Eur Spine J, 2006, 15(9):1388-1396.

West China Medical Journal

Vacuum Sealing Drainage for Early Deep Infection after Posterior Spinal Internal Fixation

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