Abstract
Aims:
Identifying and scoring risk factors that predict early wound dehiscence and progression to metalwork infection. Results of wound healing, eradication of infection and union of with the use of vacuum dressing. Compare results of serial washouts against early vacuum dressing in this group of children with significant medical co-morbidities.
Method:
A retrospective review of 300 patients with neuromuscular scoliosis who underwent posterior instrumented correction and fusion between 2008 and 2012 at two institutions. 10 patients had an early wound dehiscence which progressed to deep seated infection requiring wound washout(s) and subsequent vacuum dressing. Medical notes, clinical photographs and imaging were reviewed. Minimum follow up period was 14 months.
Results:
This study shows that readmission to PICU, presence of viscero-cutaneous devices (e.g. PEG, tracheostomy), restrictive lung disease, concomitant infection, polymicrobial (gram negative) organism and hyperlordotic deformities are cumulative risk factors to developing early wound dehiscence leading to deep seated infections. All patients in our series went on to have a sealed, non infected wound with union confirmed on CT. Patients who had multiple serial washouts (n=3–7), eventually required vacuum dressing.
Discussion:
By stratifying risk factors in patients with neuromuscular scoliosis, the occurrence of wound dehiscence can be predicted. With higher risk factor scores, early vacuum dressing is recommended as multiple serial wound washouts have poor results and with added morbidity to the patient.
Conflicts of Interest: No conflicts of interest
