Safety and Efficacy of Negative Pressure Wound Therapy for Deep Spinal Wound Infections After Dural Exposure, Durotomy, or Intradural Surgery.
Adult
Aged
Aged, 80 and over
Comorbidity
Dura Mater
/ surgery
Female
Follow-Up Studies
Humans
Male
Middle Aged
Negative-Pressure Wound Therapy
Patient Safety
Reoperation
Retrospective Studies
Spinal Diseases
/ complications
Spine
/ surgery
Surgical Wound Infection
/ microbiology
Treatment Outcome
Young Adult
Dura
NPWT
Revision surgery
Spinal infection
Spinal surgery
Spine
VAC
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
Feb 2020
Feb 2020
Historique:
received:
30
06
2019
revised:
22
10
2019
accepted:
23
10
2019
pubmed:
5
11
2019
medline:
17
3
2020
entrez:
4
11
2019
Statut:
ppublish
Résumé
Negative pressure wound therapy (NPWT) for deep spinal wound infections after exposure or opening of the dura can carry significant risks (i.e., cerebrospinal fluid infections and fistulas). In the present study, we reviewed a fairly large and recent experience with such patients. We identified 25 patients with exposure and/or incision of the dura who had undergone NPWT from January 2014 to June 2018 for deep spinal wound infections. The demographic data, specifics of primary surgery and NPWT (i.e., dressing changes, duration, time required for wound healing), patients' clinical course, outcomes, and microbiological findings were studied. Application of a Granufoam vacuum dressing with a continuous negative pressure of 60 mm Hg was performed after proper debridement. Of the 25 patients, 13 were women and 12 were men (median age, 69 years). They had primarily undergone treatment for spinal tumors (n = 7), infections and degenerative disease (n = 8 each), or fractures (n = 2), with instrumentation in 18 patients (72%). The dura was exposed in all 25 patients and had been incised in 10 (40%) patients (intended incision, 3; accidental incision, 7). Most patients had been treated for a lumbar wound infection (64%). A microorganism was detected in 84% of the cases, with Staphylococcus aureus accounting for most of the infections (48%). NPWT was concluded after a median of 4 dressing changes (range, 2-14) and 19 days (range, 10-70), with no implant removal required in any patient. NPWT application was observed to be safe without cerebrospinal fluid-related complications. The presence of comorbidities (28% had diabetes) had no effect on the treatment results. NPWT can be safely applied for deep spinal wound infections after dura exposure or durotomy during previous spine surgery.
Sections du résumé
BACKGROUND
BACKGROUND
Negative pressure wound therapy (NPWT) for deep spinal wound infections after exposure or opening of the dura can carry significant risks (i.e., cerebrospinal fluid infections and fistulas). In the present study, we reviewed a fairly large and recent experience with such patients.
METHODS
METHODS
We identified 25 patients with exposure and/or incision of the dura who had undergone NPWT from January 2014 to June 2018 for deep spinal wound infections. The demographic data, specifics of primary surgery and NPWT (i.e., dressing changes, duration, time required for wound healing), patients' clinical course, outcomes, and microbiological findings were studied. Application of a Granufoam vacuum dressing with a continuous negative pressure of 60 mm Hg was performed after proper debridement.
RESULTS
RESULTS
Of the 25 patients, 13 were women and 12 were men (median age, 69 years). They had primarily undergone treatment for spinal tumors (n = 7), infections and degenerative disease (n = 8 each), or fractures (n = 2), with instrumentation in 18 patients (72%). The dura was exposed in all 25 patients and had been incised in 10 (40%) patients (intended incision, 3; accidental incision, 7). Most patients had been treated for a lumbar wound infection (64%). A microorganism was detected in 84% of the cases, with Staphylococcus aureus accounting for most of the infections (48%). NPWT was concluded after a median of 4 dressing changes (range, 2-14) and 19 days (range, 10-70), with no implant removal required in any patient. NPWT application was observed to be safe without cerebrospinal fluid-related complications. The presence of comorbidities (28% had diabetes) had no effect on the treatment results.
CONCLUSIONS
CONCLUSIONS
NPWT can be safely applied for deep spinal wound infections after dura exposure or durotomy during previous spine surgery.
Identifiants
pubmed: 31678318
pii: S1878-8750(19)32784-6
doi: 10.1016/j.wneu.2019.10.146
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e624-e630Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.