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Use of vacuum assisted closure in instrumented spinal deformities for children with postoperative deep infections
Federico Canavese1, Joseph I Krajbich
1Department of Orthopedics, Shriners Hospital for Children, 3101 SW Sam Jackson Park Road, Oregon 97239, Portland, USA.
Insights
Vacuum-assisted closure (VAC) effectively treats deep spinal infections in children with spinal instrumentation. This method preserves spinal hardware and correction, proving reliable for susceptible patients.
Area of Science:
- Pediatric surgery
- Orthopedic surgery
- Infectious disease management
Background:
- Deep spinal infections are common in pediatric patients with instrumented spinal deformities.
- Children with cerebral palsy and spina bifida are particularly vulnerable to these infections.
- Vacuum-assisted closure (VAC) is an emerging technique for challenging wound healing.
Purpose of the Study:
- To review the efficacy of the VAC system for deep spinal infections post-spinal instrumentation in children.
- To evaluate VAC's impact on hardware retention and spinal correction.
- To assess the success rate of VAC in treating pediatric deep spinal surgical site infections.
Main Methods:
- A review of 33 pediatric patients treated with wound VAC for deep postoperative spinal infections.
- Analysis of clinical and laboratory data.
- Assessment of spinal hardware retention, correction loss, and recurrent infections.
Main Results:
- All 33 patients completed VAC treatment successfully.
- No significant loss of spinal correction was observed in most patients.
- One patient required partial hardware removal due to persistent infection; laboratory indices normalized in most.
Conclusions:
- Wound VAC is a valuable tool for spinal surgeons managing deep infections in pediatric patients, especially those with neuromuscular diseases.
- The technique facilitates the retention of spinal instrumentation and maintains spinal correction.
- Wound VAC is a reliable and user-friendly treatment option for these complex cases.
Background:
Postoperative deep infections are relatively common in children with instrumented spinal deformities, whose healing potential is somewhat compromised. Children with underlying diagnosis of cerebral palsy, spina bifida and other chronic debilitating conditions are particularly susceptible. Vacuum-assisted closure (VAC) is a newer technique to promote healing of wounds resistant to treatment by established methods. This article aims to review the efficacy of the VAC system in the treatment of deep spinal infections following spinal instrumentation and fusion in children and adolescents.
Materials And Methods:
We reviewed 33 patients with deep postoperative surgical site infection treated with wound VAC technique. We reviewed clinical and laboratory data, including the ability to retain the spinal hardware, loss of correction and recurrent infections.
Results:
All patients successfully completed their wound VAC treatment regime. None had significant loss of correction and one had persistent infection requiring partial hardware removal. The laboratory indices normalized in all but three patients.
Conclusions:
Wound VAC technique is a useful tool in the armamentarium of the spinal surgeon dealing with patients susceptible to wound infections, especially those with neuromuscular diseases. It allows for retention of the instrumentation and maintenance of the spinal correction. It is reliable and easy to use.
