Vacuum-Assisted Closure in Patients with Post-operative Infections after Instrumented Spine Surgery: A Series of 12 Cases

INTRODUCTION: Post-operative wound infections after spinal surgery is a very serious problem, leading to a risk of significant morbidity which may even lead to prolonged hospitalization. Various treatment protocols have been recommended for debridement, antibiotic, and soft-tissue management, but with mixed results. However, the risk of morbidity is still high with these treatment options. Vacuum-assisted closure (VAC) system has been gaining popularity recently in the management of subacute, acute, and chronic wounds. This study aims to review the use of the indigenous VAC in the management of deep infections after spinal instrumentation surgery. CASE SERIES: Between 2010 and 2015, 12 out of 514 patients who developed a deep infection after spinal surgery, were selected and reviewed retrospectively at multiple centers (MGM Hospital, Kamothe and Center for Orthopaedic & Spine Surgery, New Panvel, Navi Mumbai, India). Out of 12 patients, one of the patients needed a partial implant exchange although none of the cases needed complete implant removal. All patients had achieved clean closed wounds along with a retention of the instrumentation. There was no need for flap surgery to cover wound defect in any case. However, antibiotic treatment was necessary in all cases. None of the patients showed a new infection after the treatment. CONCLUSION: The study demonstrates the usefulness of VAC therapy as an alternative management for wound conditioning of a back wound with the high complexity in nature after instrumented spine surgeries as it eliminates complex secondary surgeries, prolong use of antibiotics and removal of the implants.