A case of deep infection after instrumentation in dorsal spinal surgery: the management with antibiotics and negative wound pressure without removal of fixation

Abstract

Until today the role of spinal instrumentation in the presence of a wound infection has been widely discussed and recently many authors leave the hardware in place with appropriate antibiotic therapy. This is a case of a 65-year-old woman suffering from degenerative scoliosis and osteoporotic multiple vertebral collapses treated with posterior dorsolumbar stabilisation with screws and rods. Four months later, skin necrosis and infection appeared in the cranial wound with exposure of the rods. A surgical procedure of debridement of the infected tissue and package with a myocutaneous trapezius muscle flap was performed. One week after surgery, negative pressure wound therapy was started on the residual skin defect. The wound healed after 2 months. The aim of this case report is to focus on the utility of this method even in the case of hardware exposure and infection. This may help avoid removing instrumentation and creating instability.

Keywords: Infection (neurology); Infections; Spinal Cord; Surgery.

Figure 1

Patient came to our attention with severe kyphosis and evident spinal instrumentation at the subcutaneous level.

Figure 2

Extension of stabilisation to the cervical level.

Figure 3

Wound dehiscence after extension of stabilisation to the cervical level.

Figure 4

Wound dehiscence after the second surgical procedure of cervical instrumentation removal.

Figure 5

Revision of the surgical wound with a myocutaneous trapezius muscle flap.

Figure 6

Little wound dehiscence after surgical wound revision.

Figure 7

Vacuum-assisted closure.

Figure 8

Wound closure after 2 months of VAC. VAC, vacuum-assisted closure.