Wound infection after spinal fusion in children with cerebral palsy

One hundred and seventy-two children with cerebral palsy were operated on for neuromuscular scoliosis by spinal fusion with unit rod instrumentation between January 1988 and June 1996. There were 15 (8.7%) postoperative wound infections (seven deep, eight superficial) in 15 patients (five males, 10 females) who had a mean age of 13.9 years. The mean follow-up after diagnosis of infection was 3.3 years (range, 1-7.2). Twelve of the 15 infected cases, including all seven deep infections, occurred in the distal portion of the incision. In 14 patients, the wound infections were diagnosed within the first 2 months of the original spinal fusion. All the superficial wound infections were treated successfully by local wound care and intravenous antibiotics. The removal of hardware was necessary in the one late deep wound infection that occurred 2 years after the spinal fusion. The remaining six deep infections were treated by irrigation and debridement with the wound left open, allowing it to heal by secondary intention. One patient's wound was closed over suction-irrigation drains; however, due to a recurrent abscess, the wound was reopened and allowed to granulate. All the wound infections occurred in severely neurologically involved spastic quadriplegics who were nonambulatory and severely mentally retarded and had seizure disorders.