Samo Hrašovec1, Gregor Rečnik1. 1. Department of Orthopaedic Surgery, University Medical Center Maribor, Maribor, Slovenia.
Abstract
INTRODUCTION: The advantages of using negative pressure wound therapy with instillation and dwell time (NPWTi-d) of a topical solution that dwells on the wound have been shown to include removal of fibrinous and bacterial exudate and increased granulation tissue formation. The treatment is best suited for chronic, complex wounds with areas of nonviable tissue on the wound surface. CASE REPORT: A 73-year-old female with spondylolisthesis and stenosis of the spinal canal experienced dehiscence formation of the postoperative wound with continuous exudate after fusion and decompression surgery (TLIF L4-L5) of the lumbar spine. As a result, she had a complicated clinical course with multiple revision surgeries. Negative pressure wound therapy with continuous negative pressure was utilized for about 6 weeks, and regular dressing changes (saline gauze and honey dressings) were performed every day until NPWTi-d treatment was initiated; this protocol was not successful, so NPWTi-d with saline solution was initiated (average instillation time, 4 hours; dwell time, 15 minutes; continuous negative pressure, -125 mm Hg). During the course of therapy, 10 dressing changes were performed 3 to 5 days apart. After 31 days of therapy, healthy granulation tissue with minimal exudate was noted. Complete wound closure was achieved after 5 months of treatment. CONCLUSIONS: Negative pressure wound therapy with instillation and dwell time can enhance the healing potential of a complex surgical wound after spinal fusion.
INTRODUCTION: The advantages of using negative pressure wound therapy with instillation and dwell time (NPWTi-d) of a topical solution that dwells on the wound have been shown to include removal of fibrinous and bacterial exudate and increased granulation tissue formation. The treatment is best suited for chronic, complex wounds with areas of nonviable tissue on the wound surface. CASE REPORT: A 73-year-old female with spondylolisthesis and stenosis of the spinal canal experienced dehiscence formation of the postoperative wound with continuous exudate after fusion and decompression surgery (TLIF L4-L5) of the lumbar spine. As a result, she had a complicated clinical course with multiple revision surgeries. Negative pressure wound therapy with continuous negative pressure was utilized for about 6 weeks, and regular dressing changes (saline gauze and honey dressings) were performed every day until NPWTi-d treatment was initiated; this protocol was not successful, so NPWTi-d with saline solution was initiated (average instillation time, 4 hours; dwell time, 15 minutes; continuous negative pressure, -125 mm Hg). During the course of therapy, 10 dressing changes were performed 3 to 5 days apart. After 31 days of therapy, healthy granulation tissue with minimal exudate was noted. Complete wound closure was achieved after 5 months of treatment. CONCLUSIONS: Negative pressure wound therapy with instillation and dwell time can enhance the healing potential of a complex surgical wound after spinal fusion.