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

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.

Fig. 1

The figure shows a wound fistula with secretion of a patient (No 11) 28 days after spinal instrumentation (a), a deep subfascial infection of the wound (b), a second look operation that included thorough debridement, implant redislocation and repeated irrigation with normal saline solution (c), the temporary coverage of the open wound during treatment of infection by V.A.C.™ system (d) and the final healing (e). Second look intervention with changes of V.A.C.™ were carried out in dependence of the wound and patients conditions