MODIFICATION OF THE NEGATIVE PRESSURE THERAPY TECHNIQUE FOR TREATMENT OF WOUND INFECTION AFTER SPINAL SURGERY

ABSTRACT Objective To describe the indications and contraindications of negative pressure assisted wound therapy as well as a modification to the negative pressure technique that has been shown to shorten the number of changes of dressings and hospital stay with the early closure of the wound. Methods A review of the existing literature in the databases OVID, PubMed, Cochrane and Medigraphic was carried out in relation to the pressure-assisted closure of wounds. This is a non-invasive and active healing system that uses localized and controlled negative pressure, which consists of a specialized dressing that includes reticulated foam that removes the exudates through a tube to an airtight container. This set forms microdeformations in the wound bed, which are known to cause an important increase in fibroblastic migration and consequently of higher quality tissue, granulation tissue formation and angiogenesis. Results It was found that this method shortens the number of days of hospital stay. The technique describes the primary closure of the wound after intense cleansing and debridement of the non-viable tissue and signs of infection. Conclusions Negative pressure wound therapy is effective for the treatment of deep infections in postsurgical spinal wound, with average time of use of 1 to 4 weeks in the most severe cases. Level of evidence IV; Case Series.

摘要
目的：阐述负压辅助伤口治疗（negative pressure assisted wound therapy）的适应证与禁忌证，同时介绍一种经证实可减少换药次数、缩短住院时长并促进伤口早期闭合的负压治疗改良技术。
方法：针对伤口负压辅助闭合技术，在OVID、PubMed、Cochrane及Medigraphic数据库中检索现有文献并进行综述。负压辅助伤口治疗属于无创主动愈合系统，通过局部可控负压实现治疗：其专用敷料包含网状泡沫，可将渗出液经管路引流至密闭容器。该装置可在伤口床形成微形变，此类微形变已被证实可显著促进成纤维细胞迁移，进而生成更高质量的组织、促进肉芽组织形成与血管新生。
结果：研究证实该方法可缩短住院时长。该技术的操作流程为：对伤口进行彻底清创，清除失活组织与感染征象后，对伤口实施一期缝合。
结论：负压伤口治疗对脊柱术后伤口深部感染具有良好疗效，重症患者的平均治疗时长为1至4周。证据等级：IV级；病例系列研究。