Classification and Management Algorithm for Postoperative Wound Complications Following Transforaminal Lumbar Interbody Fusion
| Autor: | Ajoy Prasad Shetty, Karukayil Ramakrishnan Renjith, Shanmuganathan Rajasekaran, Rishi Mugesh Kanna |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Debridement medicine.diagnostic_test business.industry Wound dehiscence medicine.medical_treatment lcsh:R lcsh:Medicine Context (language use) Magnetic resonance imaging Retrospective cohort study medicine.disease Classification Surgery Vertebral bone marrow edema Edema medicine Back pain Clinical Study Orthopedics and Sports Medicine Implant medicine.symptom business Surgical site infection |
| Zdroj: | Asian Spine Journal Asian Spine Journal, Vol 14, Iss 5, Pp 673-681 (2020) |
| ISSN: | 1976-1902 |
| Popis: | Study Design: Retrospective study.Purpose: Postoperative wound complications occurring after transforaminal lumbar interbody fusion (TLIF) are unique, as they can involve different tissue zones (subcutaneous, subfascial, osseous, peri-implant, and disc). Overview of Literature: Management of postoperative infections occurring after TLIF remains controversial in the context of retention or removal of implants.Methods: A total of 1,279 consecutive patients (1,520 segments) who underwent TLIF with a minimum follow-up of 1 year were analyzed. Patients with wound complications were classified anatomically into the following five types: type 1, suprafascial necrosis; type 2, wound dehiscence; type 3, pus around screws and rods; type 4, bone marrow edema; and type 5, pus in the disc space. Details pertaining to clinicoradiological and laboratory findings and management were also recorded.Results: Of the 62 patients (4.8%) with wound complications, there were seven patients in type 1, 35 in type 2, 10 in type 3, four in type 4, and six in type 5. Patients in types 1 and 2 manifested delayed wound healing and were systemically well. In type 1, five patients were managed with resuturing and two were managed conservatively. In type 2, all patients had wound gaping and were managed by debridement, whereas three patients required vacuum-assisted closure. Patients in type 3 had severe back pain and fever, with demonstrable pus around the screw site. Tissue culture identified organisms in 90% of the patients. Patients in type 4 presented with increasing back pain, and magnetic resonance imaging revealed vertebral bone marrow edema. Those in type 5 had severe back pain and fever, with demonstrable pus in the disc space. Patients in types 3–5 required debridement, implant revision/retention, and long-term antibiotics.Conclusions: The new anatomical classification of surgical site infections could help grade the severity of infection and provide tangible treatment guidelines, resulting in better infection clearance and patient outcomes. |
| Databáze: | OpenAIRE |
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