Abstract
Introduction
Deep wound infection (DWI) is a complication associated with poorer outcome and increased costs. The DWI rates increased in the last decade especially because of the use of spinal instrumentation. Although this condition is important for the surgical outcome, there is still no agreement about the about the need to remove the instrumentation. The objective is to describe the authors' experience in managing DWI without the removal of instrumentation after performing a procedure on the lumbar spine and the clinical and functional long-term course of these patients.
Patients and Methods
A prospective cohort study with the patients who presented deep infection of the surgical wound. All the patients with a clinical suspicion of this complication were submitted to an aggressive protocol of wound opening, collection of material for a microbiological examination, exhaustive washing, debridement, implementation of a continuous washing system, primary suturing of the wound, and treatment with antibiotics IV and then orally. The instrumentation was not removed from any patient. The patients were evaluated radiologically, clinically, functionally, and by blood test examination, white blood cell count, erythrocyte sedimentation rate, and C-reactive protein, during the follow-up. Paired analyses were performed using the Wilcoxon test to evaluate changes in the instrument scores.
Results
The mean age was 59.31 ( ± 13.17) and most of the patients were female (94.7%; 18/19). At least one comorbidity was observed in 68.4% of the patients, the most frequent being obesity, present in 26.3% of the patients. The mean period for the identification of DWI was 2 weeks and 57.9% underwent only one wound exploration. Staphylococcus aureus was the most common microorganisms (n = 13 cases, 68.4%). Blood tests showed a significant decrease of the WBC, ESR, and CRP 6 weeks' posttreatment when compared with pretreatment values. Comparing the 6 weeks' posttreatment evaluation and the final evaluation, a significant reduction of ESR and CRP was also observed.
Conclusion
Patients with DWI after posterior lumbar spinal instrumentation fusion can be treated without removal of the instrumentation through an aggressive protocol of wound exploration, extensive washing, debridement of necrotic tissue, closed irrigation system during 5 days, and proper antibiotic therapy. The WBC, ESR, and CRP blood tests were not useful to predict the need for surgical reinterventions. Despite the complication, the patients presented improvement with respect to pain, functional capacity, and preoperative quality of life.