Use of incisional vacuum-assisted closure in the prevention of postoperative infection in high-risk patients who underwent spine surgery: a proof-of-concept study

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>This proof-of-concept study was conducted to determine whether negative-pressure wound therapy, through the use of incisional vacuum-assisted closure (VAC), is associated with a reduction in surgical site infections (SSIs) when compared to standard wound dressings in patients undergoing open posterior spinal fusion who have a high risk of infection.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A total of 64 patients were examined; 21 patients received incisional VAC application (VAC group) versus 43 diagnosis-matched patients who received standard wound dressings (control group). Patients in the VAC group were prospectively enrolled in a consecutive series between March 2013 and March 2014 if they met the following diagnostic criteria for high risk of infection: posterior open surgery across the cervicothoracic junction; thoracic kyphosis due to metastatic disease; high-energy trauma; or multilevel revision reconstructive surgery. Patients in the VAC group also met one or more comorbidity criteria, including body mass index ≥ 35 or &lt; 18.5, diabetes, previous radiation at surgical site, chemotherapy, steroid use, bedridden state, large traumatic soft-tissue disruption, or immunocompromised state. Consecutive patients in the control group were retrospectively selected from the previous year by the same high-risk infection diagnostic criteria as the VAC group. All surgeries were conducted by the same surgeon at a single site. The primary outcome was SSI. All patients had 1 year of follow-up after their surgery. Baseline demographics, intraoperative parameters, and postoperative wound infection rates were compared between groups.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Patient demographics including underlying comorbidities were similar, with the exception that VAC-treated patients were malnourished (p = 0.020). VAC-treated patients underwent longer surgeries (p &lt; 0.001) and required more postoperative ICU admissions (p = 0.039). The median length of hospital stay was not different between groups. In total, 9 control patients (21%) developed an SSI, versus 2 VAC-treated patients (10%).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Patients in this cohort were selected to have an increased risk of infection; accordingly, the rate of SSI was high. However, negative-pressure wound therapy through VAC application to the postoperative incision resulted in a 50% reduction in SSI. No adverse effects were noted secondary to VAC application. The preliminary data confirm the authors’ proof of concept and strongly support the need for a prospective randomized trial.</jats:p></jats:sec>

Closed incision negative pressure therapy following abdominoplasty after breast reconstruction with deep inferior epigastric perforator flaps

“…Application of ciNPT has been reported to help create a closed environment over the incision, hold the wound edges together, reduce oedema, promote perfusion, and remove exudate via the application of constant negative pressure. Use of ciNPT has shown positive postoperative outcomes in patient populations with closed incisions resulting from groin wounds in vascular surgery, sternal reconstructive surgery, spine surgery, hip arthroplasty, and laparotomy . In this pilot study of 10 DIEP flap breast reconstruction patients, we compared outcomes of patients treated with ciNPT vs standard occlusive dressings.…”

The Historical Role of the Plastic Surgeon in Spine Reconstruction

“…22 Dyck et al have shown that the use of NPWT in the prevention of postoperative infection in high-risk patients who underwent spine surgery resulted in 50% reduction in surgical site infections. 23 In addition, others have shown not only a significant reduction in the incidence of postoperative wound infection but also wound dehiscence. 24 Following reconstruction, the patient receives q2H turns and lateral positioning during recovery so that pressure is avoided on the closure.…”

Negative pressure wound therapy in spinal fusion patients

“…The use of NPWT in spine surgery has traditionally been in the treatment of post‐operative wound complications, including SSI 12,13 . More recently, it has been suggested that the use of ciNPT may reduce the incidence of SSI following spinal fusion procedures 14,15 . However, its potential applications in spinal surgery needs further clarification.…”

“…12,13 More recently, it has been suggested that the use of ciNPT may reduce the incidence of SSI following spinal fusion procedures. 14,15 However, its potential applications in spinal surgery needs further clarification.…”