• Robert Lee, Daniel Beder, John Street, Michael Boyd, Charles Fisher, Marcel Dvorak, Scott Paquette, and Brian Kwon.
• Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK. robertlee1@nhs.net.
• Eur Spine J. 2018 Oct 1; 27 (10): 2536-2542.

IntroductionThe treatment of postoperative deep spinal wound infection involves debridement and intravenous antibiotics. Authors have previously reported success in a small series of patients treated with vacuum-assisted closure (VAC) therapy, but its use over exposed dura is controversial and the outcome has not been reported in large series.PurposeTo review the outcomes following the treatment of postoperative spinal infections with VAC therapy, particularly those with exposed dura.MethodsThis is a review of prospectively collected data in 42 patients, all of whom had deep postoperative spinal infections. 30 of these patients had exposed dura. All patients had an initial debridement followed by application of VAC Whitefoam (with exposed dura) or grey Granufoam (where no dura was exposed). Pressure was set at 50 mmHg with exposed dura or 125 mmHg where no dura was exposed. All patients underwent a minimum 6 week course of antibiotics. We report on the number of visits to theatre required for dressing changes and debridement and the eventual outcomes.ResultsFive patients required a flap reconstruction. Two patients died before definitive final closure due to other complications (pneumonia and stroke). In all the other patients, their wounds healed fully. A mean of 2.3 infection surgeries were required to eradicate infection and achieve wound closure.ConclusionsThis is one of the largest studies which confirms the safety and efficacy of VAC dressings in patients with spinal wound infections, even when the dura is exposed. These slides can be retrieved under Electronic Supplementary Material.

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