Abstract
Revision surgery and surgery in previously operated areas are associated with an increased infection risk. In such situations, aggressive surgical debridement may be necessary to control and eradicate the infection. Full thickness defects resulting from such debridement present as a challenge. In most cases, an association of various methods, both surgical and non-surgical, is necessary.
Our goal is to describe the use of vaccum dressings as an effective way to deal with extensive and infected dorsolumbar surgical defects, while avoiding the use of myocutaneous flaps.
This is a retrospective and descriptive case report based on data from clinical records, patient observation and analysis of complementary exams.
We present the case of a 57-years-old obese woman with prior history of double approach with posterior instrumentation and spine arthrodesis (D3 to L4) due to severe dorsolumbar adolescent idiopathic scoliosis. She presented to our consult 42 years after surgery, complaining of lower back pain. Clinical observation and imaging exams demonstrated degenerative disc disease in L5-S1 and L5 anterolisthesis. There was also distal instrumentation breakage (right L4 pedicular screw and contralateral rod) with pseudarthrosis suspicion.
Distal instrumentation was removed and no pseudarthrosis was found. Therefore, posterior instrumentation and arthrodesis was performed, from L4 to S1. Surgery went without complications.
One week after surgery, patient developed fever and inflammatory signs at the surgical incision, with purulent oozing. Escherichia coli and Proteus mirabilis were identified as the causative agents.
Decision was made to remove both lumbar and distal dorsal instrumentation and perform aggressive debridement and lavage, with debridement surgery being repeated twice. Finally, a full thickness defect with approximately 20cm long and 6cm wide resulted from the debridement.
A vacuum dressing was then applied, for 5 weeks, with progressive decrease in clinical and analytical inflammatory parameters and wound closure.
Four months after the initial surgery, patient was discharged with complete defect closure and reepithelialization.
This dressing technique provided a sound solution for defect resolution, as well as an important aid for infection control. It proved to be a viable option in an extensive defect, when surgical flap techniques and traditional dressing techniques could not provide a complete solution.
