Spine surgeries can be very complex. They often involve placing hardware–rods, screws, pins, or cages–in the spine. Rates of complications are higher after these difficult procedures. Infections are more likely, and sometimes the wound fails to close or may even burst open after healing. In these cases, the hardware may become exposed.
Doctors try to get the wound to heal by cleaning up the tissue around the wound and by using antibiotics. When these measures don’t work, the wound may have to be closed by sewing a flap of skin, muscle, or soft tissue over the exposed area. But this can cause several possible complications.
The authors of this article looked at a different way to treat this problem. They reported on two cases where vacuum therapy was used to create suction over the open wound. This type of treatment is also called vacuum-assisted closure (VAC) or negative pressure therapy.
Both patients in the report were girls (ages 10 and 17) with exposed hardware after spine surgery. Both had wound infections. In both cases, the wounds were packed with a special type of sponge, sealed with special plastic, and fitted with a vacuum device. One patient used the device for six weeks. At that point, the wound was healed well enough to accept a skin graft. The second patient used the device for 10 weeks. Her wound healed without needing any further surgery and was still fine 10 months later.
Patients generally like this kind of therapy. The wound coverings don’t need to be changed as often, and the vacuum device is lightweight and portable. VAC therapy isn’t the first choice of treatment for all spine surgery patients, but it does seem to have fewer complications in difficult cases.
Doctors aren’t sure why VAC works, although the theory is that it has two helpful effects on wounds. First, the negative pressure removes extra fluid. This reduces the pressure in the wound and increases blood flow to the area. Fluids in chronic wounds may also get in the way of the healing process. Second, the suction stimulates the cells to form healthy tissue, which heals the wound better and faster.
The authors conclude that VAC therapy may prove especially useful in the healing of complex wounds where hardware is exposed. They suggest that more study is needed to determine which kinds of wounds could benefit most from VAC therapy.