Negative pressure wound therapy (NPWT) as management of surgical site infection (SSI) in spinal fusion surgery

Mislan Mislan(1*), Agung Waluyo(2), Liya Arista(3)


(1) Universitas Indonesia
(2) Universitas Indonesia
(3) Universitas Indonesia
(*) Corresponding Author

Abstract


Surgical Site Infection (SSI) following spinal fusion surgery may lead to patient morbidity, increased treatment costs, and possible recurrent medical interventions. Negative Pressure Wound Therapy (NPWT) has demonstrated promise in the management of SSI as well as assisting in surgical wound healing. This literature review aimed to evaluate the effectiveness of NPWT as a prophylactic, and treatment of SSI in spinal fusion surgery. The literature review method is conducted by searching research articles comparing NPWT and Standard Wound Dressing (SWD) effectiveness with the relevant cohort or Randomized Controlled Trial (RCT) research design using Embase, Scopus, PubMed, and ScienceDirect databases. The application treads of NPWT for surgical wounds in spinal fusion surgery were also described. The research articles were limited from 2017 to 2022. Six articles fit in criteria of inclusion, three articles were prophylactic management research, and the others were the management of treatment research. Analysis of the articles indicated that NPWT as prophylactic could effectively reduce the incidence of postoperative surgical site infections. NPWT as treatment had less time duration, lower risk of sponge fragment retainment, and fewer procedures to achieve wound closure in spinal fusion surgery. There is currently a lack of strong clinical evidence of its efficacy, so rigorous randomized prospective clinical trials are needed.

Keywords


Negative pressure wound therapy; Surgical site infection; Spinal fusion surgery

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References


Gu W, Tu L, Liang Z, Wang Z, Aikenmu K, Chu G, et al. Incidence and risk factors for infection in spine surgery: A prospective multicenter study of 1764 instrumented spinal procedures. Am J Infect Control 2018;46:8–13. https://doi.org/10.1016/j.ajic.2017.09.025.

Chen Z, Sun J, Yao Z, Song C, Liu W. Can prophylactic negative pressure wound therapy improve clinical outcomes in spinal fusion surgery? A meta-analysis. European Spine Journal 2022;31:1546–52. https://doi.org/10.1007/s00586-022-07178-y.

White AJ, Fiani B, Jarrah R, Momin AA, Rasouli J. Surgical Site Infection Prophylaxis and Wound Management in Spine Surgery. Asian Spine J 2022;16:451. https://doi.org/10.31616/ASJ.2020.0674.

White AJ, Gilad R, Motivala S, Fiani B, Rasouli J. Negative Pressure Wound Therapy in Spinal Surgery. Bioengineering 2022;9:614. https://doi.org/10.3390/bioengineering9110614.

Pesenti S, Pannu T, Andres-Bergos J, Lafage R, Smith JS, Glassman S, et al. What are the risk factors for surgical site infection after spinal fusion? A meta-analysis. European Spine Journal 2018;27:2469–80. https://doi.org/10.1007/S00586-018-5733-7/TABLES/4.

Astasio-Picado Á, Montero MDM, López-Sánchez M, Jurado-Palomo J, Cobos-Moreno P, Gómez-Martín B. The Effectiveness of Negative Pressure Therapy: Nursing Approach. J Pers Med 2022;12:1813. https://doi.org/10.3390/jpm12111813.

Zeng J, Sun X, Sun Z, Guan J, Han C, Zhao X, et al. Negative Pressure Wound Therapy Versus Closed Suction Irrigation System in the Treatment of Deep Surgical Site Infection After Lumbar Surgery. World Neurosurg 2019;127:e389–95. https://doi.org/10.1016/j.wneu.2019.03.130.

Daldal I, Senkoylu A. Strategies of management of deep spinal infection: from irrigation and debridement to vacuum-assisted closure treatment. Ann Transl Med 2020;8:33–33. https://doi.org/10.21037/atm.2019.11.60.

Foglia E, Ferrario L, Garagiola E, Signoriello G, Pellino G, Croce D, et al. ClinicoEconomics and Outcomes Research Dovepress Economic and organizational sustainability of a negative-pressure portable device for the prevention of surgical-site complications. ClinicoEconomics and Outcomes Research 2017;2017:9–343. https://doi.org/10.2147/CEOR.S128139.

Nordmeyer M, Pauser J, Biber R, Jantsch J, Lehrl S, Kopschina C, et al. Negative pressure wound therapy for seroma prevention and surgical incision treatment in spinal fracture care. Int Wound J 2016;13:1176–9. https://doi.org/10.1111/iwj.12436.

Naylor RM, Gilder HE, Gupta N, Hydrick TC, Labott JR, Mauler DJ, et al. Effects of Negative Pressure Wound Therapy on Wound Dehiscence and Surgical Site Infection Following Instrumented Spinal Fusion Surgery—A Single Surgeon’s Experience. World Neurosurg 2020;137:e257–62. https://doi.org/10.1016/j.wneu.2020.01.152.

Lambrechts MJ, D’Antonio ND, Issa TZ, Levy HA, Yalla GR, Berthiaume E, et al. The Usefulness of Closed Incision Negative Pressure Wound Therapy After Spinal Fusion: A Systematic Review and Meta-Analysis. World Neurosurg 2022. https://doi.org/10.1016/j.wneu.2022.09.048.

Barillo DJ, Barillo AR, Korn S, Lam K, Attar PS. The antimicrobial spectrum of Xeroform®. Burns 2017;43:1189–94. https://doi.org/10.1016/J.BURNS.2016.10.023.

Akhter AS, McGahan BG, Close L, Dornbos D, Toop N, Thomas NR, et al. Negative pressure wound therapy in spinal fusion patients. Int Wound J 2021;18:158–63. https://doi.org/10.1111/iwj.13507.

Dyck BA, Bailey CS, Steyn C, Petrakis J, Urquhart JC, Raj R, et al. Use of incisional vacuum-assisted closure in the prevention of postoperative infection in high-risk patients who underwent spine surgery: a proof-of-concept study. J Neurosurg Spine 2019;31:430–9. https://doi.org/10.3171/2019.2.SPINE18947.

Shi H, Zhu L, Jiang ZL, Huang ZH, Wu XT. The use of incisional vacuum-assisted closure system following one-stage incision suture combined with continuous irrigation to treat early deep surgical site infection after posterior lumbar fusion with instrumentation. J Orthop Surg Res 2021;16. https://doi.org/10.1186/s13018-021-02588-y.

Lavelle WF, Kurra S, Rashid A, Yirenkyi H, Castle P. Management of Spine Surgical Site Wound Infections Outcomes of Negative Pressure Wound Therapies in the 2020. https://doi.org/10.14444/7110.

Zhou J, Wang R, Huo X, Xiong W, Kang L, Xue Y. Incidence of Surgical Site Infection After Spine Surgery: A Systematic Review and Meta-analysis. Spine (Phila Pa 1976) 2020;45:208–16. https://doi.org/10.1097/BRS.0000000000003218.

Deng H, Chan AK, Ammanuel SG, Chan AY, Oh T, Skrehot HC, et al. Risk factors for deep surgical site infection following thoracolumbar spinal surgery. J Neurosurg Spine 2019;32:292–301. https://doi.org/10.3171/2019.8.SPINE19479.

Gayatri D. Perkembangan Manajemen Perawatan Luka : Dulu dan Kini. Jurnal Keperawatan Indonesia 2014;2:304–8. https://doi.org/10.7454/jki.v2i8.100.

Ailaney N, Johns WL, Golladay GJ, Strong B, Kalore N v. Closed Incision Negative Pressure Wound Therapy for Elective Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Arthroplasty 2021;36:2402–11. https://doi.org/10.1016/J.ARTH.2020.11.039.

Sahebally SM, McKevitt K, Stephens I, Fitzpatrick F, Deasy J, Burke JP, et al. Negative Pressure Wound Therapy for Closed Laparotomy Incisions in General and Colorectal Surgery: A Systematic Review and Meta-analysis. JAMA Surg 2018;153. https://doi.org/10.1001/JAMASURG.2018.3467.

Zwanenburg PR, Tol BT, Obdeijn MC, Lapid O, Gans SL, Boermeester MA. Meta-analysis, Meta-regression, and GRADE Assessment of Randomized and Nonrandomized Studies of Incisional Negative Pressure Wound Therapy Versus Control Dressings for the Prevention of Postoperative Wound Complications. Ann Surg 2020;272:81–91. https://doi.org/10.1097/SLA.0000000000003644.

Karaaslan F, Erdem Ş, Mermerkaya MU. Wound management with vacuum-assisted closure in postoperative infections after surgery for spinal stenosis. Int Med Case Rep J 2015;8:7–11. https://doi.org/10.2147/IMCRJ.S76214.

Webster J, Liu Z, Norman G, Dumville JC, Chiverton L, Scuffham P, et al. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev 2019;3. https://doi.org/10.1002/14651858.CD009261.PUB4.

Kim DC, Carlson BC, Shafa E, Mehbod AA. Vacuum-Assisted Wound Closure Management for Posterior Lumbar Spine Infections. J Am Acad Orthop Surg 2022;30:395–9. https://doi.org/10.5435/JAAOS-D-17-00032.

Horch RE, Ludolph I, Müller-Seubert W, Zetzmann K, Hauck T, Arkudas A, et al. Topical negative-pressure wound therapy: emerging devices and techniques. Expert Rev Med Devices 2020;17:139–48. https://doi.org/10.1080/17434440.2020.1714434.

Normandin S, Safran T, Winocour S, Chu CK, Vorstenbosch J, Murphy AM, et al. Negative Pressure Wound Therapy: Mechanism of Action and Clinical Applications. Semin Plast Surg 2021;35:164–70. https://doi.org/10.1055/S-0041-1731792.

Agarwal P, Kukrele R, Sharma D. Vacuum assisted closure (VAC)/negative pressure wound therapy (NPWT) for difficult wounds: A review. J Clin Orthop Trauma 2019;10:845. https://doi.org/10.1016/J.JCOT.2019.06.015.

Janssen AHJ, Mommers EHH, Notter J, de Vries Reilingh TS, Wegdam JA. Negative pressure wound therapy versus standard wound care on quality of life: a systematic review. J Wound Care 2016;25:154–9. https://doi.org/10.12968/JOWC.2016.25.3.154.

Jones GA, Butler J, Lieberman I, Schlenk R. Negative-pressure wound therapy in the treatment of complex postoperative spinal wound infections: complications and lessons learned using vacuum-assisted closure. J Neurosurg Spine 2007;6:407–11. https://doi.org/10.3171/SPI.2007.6.5.407.

Foxx KC, Mesfin A, Molinari R. Negative-pressure dressing management of recurrent postoperative epidural hematoma and uncontrollable intraoperative hemorrhage in posterior spine surgery: report of 4 cases. J Neurosurg Spine 2018;28:220–5. https://doi.org/10.3171/2017.5.SPINE17387.

Alcala-Marquez C, Torrealba R, Mehbod AA, Dawson JM, Dressel TD, Transfeldt EE. Recurrent Surgical Site Infections in the Spine After Treatment With the Vacuum-assisted Closure (VAC) System. Clin Spine Surg 2018;31:351–5. https://doi.org/10.1097/BSD.0000000000000668.


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DOI: https://doi.org/10.26714/mki.7.1.2024.71-83

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