Instillation Negative Pressure Wound Therapy: An Effective Tool for Complex Spine Wounds

Objective: Infection prevention in spinal surgeries involving implantation of hardware is of utmost priority. Furthermore, successful eradication of infection in hardware salvage is likewise critical in maintaining the long-term retention of the spinal hardware construct. Approach: We report a retrospective case series of three cases where the utilization of a VAC with instillation (VACi) in conjunction with surgical debridement aided in infection control and eradication for both preimplantation and hardware salvage spine patients. Results: Three patients were included. In case 1, VACi was utilized in conjunction with surgical debridement and IV antibiotics in the setting of acute preoperative infection to eradicate infection and enable necessary spinal hardware implementation. Cases 2 and 3 are representative of VACi for salvage of exposed spinal hardware in both the early and delayed infection presentation settings. In both cases, patients developed postoperative infections following spinal instrumentation VACi was utilized in conjunction with surgical debridement and IV antibiotics. Hardware removal was avoided in both cases. All three patients healed completely without residual evidence of infection. Innovation: VACi showed its effectiveness in timely infection eradication before spinal hardware instrumentation and with postoperative spine hardware salvage. Conclusion: This case series demonstrates that VACi can provide infection eradication both preoperatively in high-risk surgical sites, facilitating necessary hardware implementation and postoperatively in situations of hardware salvage.