Application of vacuum sealing drainage in the treatment of internal fixation instrument exposure after early postoperative infection.

AIM: This retrospective study aimed to investigate the effect of vacuum sealing drainage (VSD) in the management of fractured patients with internal fixation instrument exposure caused by early postoperative infection after open reduction and internal fixation (ORIF).
METHODS: Fourteen patients (11 men, 3 women, age range 9-63 years) with spinal and extremities fractures were enrolled in this study, including atlanto-axial fracture (N.=1), thoraco-lumbar fracture (N.=1), humerus fracture (N.=1), femoral fracture (N.=2), humerus fracture together with femoral fracture (N.=1), fracture of tibia and fibula (N.=3), L1 vertebral fracture together with tibia and fibula fracture (N.=2), L1 vertebral fracture (N.=2) and L1 vertebral fracture complicated by type II diabetes (N.=1). Infections occurred at the surgical incisions 1-7 days after ORIF operation. Deep spread of the infection caused exposure of internal fixation device. All patients underwent local debridement with retention of internal fixation device. VSD foam dressings containing the drainage tube were placed into the wound, covering external fixation devices and fully eliminating the dead space of soft tissue to avoid effusion. Continuous drainage and VSD irrigation was performed for 24 h with regular replacement of VSD.
RESULTS: After 14-43 days of VSD treatment, internal fixation devices were covered by healthy granulation tissue and complete wound healing was achieved. During a postoperative follow-up period of between 2 to 52 months, physical examinations and imaging studies of all patients showed good functional recovery, no loosening of internal fixation devices, and no systemic or local infection.
CONCLUSION: The use of VSD, while retaining the internal fixation device can be safe and effective with earlier wound healing and functional recovery.