Kurra Swamy, Rashid Aymen, Yirenkyi Henaku, Castle Patrick, Lavelle William F
Department of Orthopaedic Surgery, SUNY Upstate Medical University, Syracuse, New York.
OrthoAtlanta and Sports Medicine Specialists, Stockbridge, Georgia.
Int J Spine Surg. 2020 Oct;14(5):772-777. doi: 10.14444/7110. Epub 2020 Oct 12.
Many studies report benefits using negative pressure wound therapy (NPWT) in surgical site infections (SSIs). We measured and compared efficacy and complications associated with NPWT for traditional versus suprafascial vacuum-assisted closures (VACs).
This is a retrospective chart review of consecutive SSIs managed with negative wound therapy after spinal procedures between 2012 and 2015 from a single, academic center. Patients were collected through International Classification of Diseases, Ninth Revision, procedure codes. Inclusion criteria were patients with spine SSIs managed by irrigation and debridement with a VAC device; infection occurring after spinal surgeries; and age over 18. A total of 23 consecutive patients met the criteria. We reviewed demographic data, surgical data, infectious disease data, discharge summaries, and postoperative follow-up charts. We compared and analyzed demographics, duration of VAC therapy, and reoperation rates between VAC groups. Statistical analysis was completed using analysis of variance and χ tests; ≤ 0.05 was considered statistically significant.
A total of 7 patients had traditional VACs (Group 1), and 16 patients had suprafascial VACs (Group 2). Average blood loss and number of levels involved during index surgery were not statistically significant between groups. Locations of infection occurrence were cervical spine = 3, thoracic spine = 1, and lumbar spine = 19. Reoperation rate after initial wound VAC placement was 34%, with rates significantly higher for Group 1 (71%) than Group 2 (16%), = 0.02. Average duration of wound therapy was longer in Group 1 (77 days) than Group 2 (33 days), = 0.08. Average number of operating room visits after initial wound VAC implantation were 0.7 for Group 1 and 0.3 for Group 2, = 0.26, before obtaining a clean wound closure.
Small sample size and retrospective nature were limitations. Negative pressure wound therapy may be useful for managing spinal infections, and suprafascial VAC had less time duration, lower risk of sponge fragment retainment, and fewer procedures to ultimately achieve wound closure.
许多研究报告了在手术部位感染（SSIs）中使用负压伤口治疗（NPWT）的益处。我们测量并比较了传统负压伤口治疗与筋膜上真空辅助闭合（VAC）治疗相关的疗效和并发症。
这是一项对2012年至2015年期间在单一学术中心接受脊柱手术后采用负压伤口治疗的连续性手术部位感染病例进行的回顾性图表审查。通过国际疾病分类第九版手术编码收集患者。纳入标准为通过VAC装置冲洗和清创治疗的脊柱手术部位感染患者；脊柱手术后发生的感染；以及年龄超过18岁。共有23例连续患者符合标准。我们审查了人口统计学数据、手术数据、传染病数据、出院小结和术后随访图表。我们比较并分析了VAC组之间的人口统计学、VAC治疗持续时间和再次手术率。使用方差分析和χ检验完成统计分析；P≤0.05被认为具有统计学意义。
共有7例患者接受传统VAC治疗（第1组），16例患者接受筋膜上VAC治疗（第2组）。两组在初次手术期间的平均失血量和受累节段数无统计学差异。感染发生部位为颈椎=3例，胸椎=1例，腰椎=19例。初次伤口放置VAC后再次手术率为34%，第1组（71%）显著高于第2组（16%），P=0.02。第1组伤口治疗的平均持续时间（77天）长于第2组（33天），P=0.08。在获得清洁伤口闭合之前，初次伤口植入VAC后第组1的平均手术室就诊次数为0.7次，第2组为0.3次，P=0.26。
样本量小和回顾性研究性质是局限性所在。负压伤口治疗可能有助于管理脊柱感染，筋膜上VAC治疗持续时间更短，海绵碎片残留风险更低，最终实现伤口闭合所需的手术更少。
3级
