title: Negative-pressure wound therapy in the treatment of complex postoperative spinal wound infections: complications and lessons learned using vacuum-assisted closure.
abstract: OBJECTIVE
  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.
authors.affiliation: Cleveland Clinic Spine Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: G Alexander
authors.initials: GA
authors.lastname: Jones
authors.forename: John
authors.initials: J
authors.lastname: Butler
authors.forename: Isador
authors.initials: I
authors.lastname: Lieberman
authors.forename: Richard
authors.initials: R
authors.lastname: Schlenk
mesh_terms: D000328:Adult; D000368:Aged; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011312:Pressure; D012189:Retrospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000601:surgery*; D013530:Surgical Wound Infection / Q000628:therapy*; D007507:Therapeutic Irrigation; D016896:Treatment Outcome; D014618:Vacuum; D014945:Wound Healing / Q000502:physiology*