title: Treatment of postoperative infection after posterior spinal fusion and instrumentation in a patient with neuromuscular scoliosis.
abstract: According to the literature, patients with neuromuscular scoliosis have a higher rate of infection after spinal fusion. No randomized controlled trials have been completed to assess the optimal treatment and related outcomes for patients with infections after posterior spinal fusion. In this article, we examine the data and report a case in which a vacuum-assisted closure (VAC) device was used as definitive treatment for a deep wound infection after posterior spinal fusion and instrumentation in a patient with neuromuscular scoliosis. Our patient, a 17-year-old adolescent girl with progressive neuromuscular scoliosis, underwent posterior spinal fusion with instrumentation and bone graft from T2 to sacrum without complication. One month after surgery, she presented with a draining wound. She underwent repeat surgical irrigation and debridement with subsequent use of a wound VAC. The wound VAC was used for more than 2 months, until skin closure was complete. The deep polymicrobial wound infection was treated successfully and definitively with a wound VAC. This case report suggests that good long-term outcomes can be achieved with use of a wound VAC for definitive closure, with possible avoidance of other secondary surgeries requiring skin grafts or flaps for wound closure.
authors.affiliation: Wellmont Orthopaedic Residency Program, DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Kingsport, TN. pjghattas@gmail.com.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Ghattas
authors.forename: Charles T
authors.initials: CT
authors.lastname: Mehlman
authors.forename: David
authors.initials: D
authors.lastname: Eichten
mesh_terms: D000293:Adolescent; D003646:Debridement; D005260:Female; D006801:Humans; D054843:Negative-Pressure Wound Therapy; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation; D013530:Surgical Wound Infection / Q000601:surgery*; D007507:Therapeutic Irrigation; D016896:Treatment Outcome