LAUSR

OBJECTIVE To introduce a novel technique of using incisional vacuum-assisted closure (VAC) following one-stage incision suture combined with closed suction irrigation system (CSIS) for treating early deep surgical site infection (SSI) after posterior lumbar fusion with instrumentation and to compare it with traditional CSIS. METHODS This was a retrospective study. Patients with early deep SSI after posterior lumbar fusion with instrumentation from January 2013 to May 2020 who were treated by meticulous debridement followed by either CSIS or incisional VAC following one-stage incision suture combined with CSIS were identified. The demographic characteristics, treatment features, and outcomes were analyzed and compared between two treatment methods. RESULTS A total of 48 patients (48/5016, 0.96%) developed early deep SSI, 46 of whom were enrolled in this study, including 24 patients in CSIS group (group I) and 22 patients in incisional VAC following one-stage incision suture combined with CSIS group (group II). All patients received a follow-up with an average of 19.7 months (range 13-30 months). There were no significant differences in demographic characteristics in both groups (P > 0.05). The number of VAC foam dressing or ordinary dressing change (P < 0.001), number of debridement (P = 0.028), intravenous antibiotic duration (P = 0.042), oral antibiotic duration (P = 0.019), and hospital stay (P = 0.029) in group I were significantly more than those in group II. The irrigation duration in group I was significantly shorter than that in group II (P = 0.007). All patients were eventually cured with satisfactory outcomes. CONCLUSIONS Compared with CSIS, incisional VAC following one-stage incision suture combined with CSIS may be recommended considering that it has less dressing changes, less debridements, longer irrigation duration, shorter duration of antibiotic use, shorter hospital stay, and more convenient nursing care.