Wound management practices in surgery for adolescent idiopathic scoliosis

Management of the spine incision in the surgical treatment of adolescent idiopathic scoliosis (AIS) is critical because the wounds are complex, their length and location make their appearance a potential source of dissatisfaction, and infection is morbid. In contrast with arthroplasty, where wounds are similarly critical and standardized protocols exist, there is no agreement on the optimal management of spine wounds in AIS. Accordingly, this study aims to characterize contemporary wound management practices in AIS surgery and identify areas of agreement and variability to inform future standardization efforts.

A cross-sectional questionnaire was administered to pediatric orthopaedic and spine surgeons at five United States (U.S.) academic centers. Eligible participants had >5 years of practice and managed >30 AIS cases annually. Surveys were collected via Research Electronic Data Capture (REDCap) and assessed intraoperative and postoperative practices. Participation was voluntary and anonymous. Agreement was defined as ≥75%.

Thirty-one surgeons completed the survey (87.1% orthopaedic, 12.9% neurosurgical); 61.3% primarily treated pediatric patients. Irrigation practices varied, with 58.1% preferring crystalloid-only solutions. Antibiotic powder was used universally (96.8%), both in primary and high-risk cases. Drains were used by 80.6% of surgeons; type, depth, and removal criteria varied. Pediatric surgeons more often omitted or favored superficial drains, while spine-trained surgeons always placed a drain, preferably deep. Suture materials included monofilament (67.7%), braided (61.3%), and barbed (54.8%). Closure techniques varied, with 71% including a separate muscle layer, and equal numbers using interrupted versus continuous suture. Dressings varied widely, with only skin glue approaching agreement (74.2%). There was agreement on 24-hour postoperative antibiotics (90.5%). Less than half (41.9%) of the surgeons checked the wound in the hospital. Plastic surgery was consulted (74.2%) most commonly for revisions, infection, and neuromuscular cases.

Agreement was reached on drain placement, antibiotic use (powder and postoperative), skin glue, and plastic surgery consultation, while variability persisted in other aspects of wound care. These findings identify priority areas for future guideline development in AIS wound management.