title: Can infection associated with rib distraction techniques be managed without implant removal?
abstract: METHODS
  Retrospective clinical cohort study of infections in patients treated using rib distraction techniques.
  
  
  OBJECTIVE
  To determine if patients with early onset spinal deformity, who develop infection around their rib distraction implant, can be successfully managed without implant removal.
  
  
  BACKGROUND
  Vertical Expandable Prosthetic Titanium Rib (VEPTR) has gained wide acceptance for the management of progressive complex spinal deformity in children. Many children in this population have significant comorbidities and low body mass index putting them at high risk for infection. Typically, the protocol for treating all but early infection recommends implant removal. The purpose of this study is to determine if a VEPTR infection can be managed effectively without implant removal.
  
  
  METHODS
  This is an institutional review board-approved retrospective review of medical records of all patients who had VEPTR procedures and developed infections at PCMC from 2002 to 2008.
  
  
  RESULTS
  Ninety-seven patients underwent 678 VEPTR procedures. Nineteen infections developed in 16 patients, with a 2% overall rate of infection per procedure. The average body mass index (16.2) and absolute neutrophil count (8.2) were predictably low for this population. The diagnosis was varied. Infection was associated with initial implantation (31%), expansion (47%), exchange (5%), and revision (21%). Seventeen of 19 infections followed a wound dehiscence. Thirteen infections were classified as superficial and six deep. All patients were treated with initial irrigation and debridement (I&D) and intravenous antibiotics. The average duration of intravenous therapy was 58 days, followed by oral suppressive therapy for 34 days (2-126). Three patients required more than one debridement to control the infection (range, 2-4 I&D). No patient has required VEPTR removal to resolve the infection.
  
  
  CONCLUSIONS
  These data suggest that infections involving VEPTR instrumentation without fusion procedures can be effectively managed without implant removal. Nutrition and improved soft tissue management may be significant in reducing the incidence of infection in this patient population.
authors.affiliation: University of Utah and Primary Children's Medical Center, Salt Lake City, Utah 84113, USA. john.smith@hsc.utah.edu
authors.forename: John T
authors.initials: JT
authors.lastname: Smith
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Smith
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000209:etiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003646:Debridement / Q000379:methods; D020878:Device Removal; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019857:Osteogenesis, Distraction / Q000009:adverse effects / Q000379:methods*; D019736:Prostheses and Implants; D012189:Retrospective Studies; D012272:Ribs / Q000002:abnormalities / Q000601:surgery; D013122:Spinal Diseases / Q000601:surgery; D013530:Surgical Wound Infection / Q000209:etiology / Q000628:therapy*; D014025:Titanium / Q000737:chemistry; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D014025:Titanium