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Negative Pressure Wound Therapy with Instillation for Hardware Salvage: The Ohio State Experience
Jason Hehr, MD; Trevor Hodson, BS; Julie West, MS, PA-C; Ian Valerio, MD
The Ohio State University Wexner Medical Center
2019-02-15
Presenter: Jason Hehr, MD
Affidavit:
All co-authors have contributed appropriately to all aspects of this project.
Director Name: Greg Pearson, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Objectives:
To determine the utility of instillation negative pressure wound therapy to help eradicate infection and allow for definitive wound closure in patients with infected hardware.
Methods:
A retrospective chart review was performed on patients at a single institution. All patients who presented to the Plastic Surgery service with exposed or infected hardware and were treated with a combination of surgical debridement and negative pressure wound therapy with instillation (VACi), were included in our cohort. Patient outcomes, specifically hardware retention, time to closure, and complications were recorded and analyzed.
Results:
A total of 28 patients were included in this retrospective review. Eleven patients were treated for infected spinal hardware, twelve for extremity, and five for sternal hardware. Overall, 25 of 28 (89%) patients had successful retention or replacement of hardware, with clearance of infection and healed wounds. Original hardware was maintained in 17 of 28 (61%) patients. In eleven patients, original hardware was removed, with subsequent replacement in 8 (73%) of those patients after a clean wound was achieved. Average time to definitive closure was 12.6 days. Average follow-up was 135 days. All wounds remain healed without signs of infection.
Conclusions:
This series supports the idea that VACi, in combination with surgical debridement and antibiotic therapy, is an effective adjunct therapy to help expeditiously eradicate hardware infection allowing for hardware retention.
