Abstract
BackgroundDeep surgical site infections (dSSIs) after instrumented spinal surgery pose major therapeutic challenges. Standard treatment involves surgical debridement, wound drainage, and long-term antibiotic administration. Autologous platelet-rich fibrin (PRF) constitutes a biomaterial obtained from patients’ own blood that contains leukocytes, chemokines and growth factors boosting cicatrization. Due to favorable results reported from other surgical disciplines such as dentistry, orthopedics, maxillofacial and plastic surgery using PRF, the authors hypothesized that PRF augmentation will promote wound healing in dSSIs.ObjectiveTo report our preliminary results on the safety and efficacy of autologous-PRF as an add-on therapy on a pilot case series of persistent dSSI after instrumented spinal surgery.MethodsAmong the 293 patients who underwent dorsal decompression and stabilization of the cervical, thoracic, and lumbar spine due to degenerative diseases in our department, 12 patients (4%) presented persisting dSSI after standard wound debridement and antibiotic treatment. PRF augmentation was used during a second surgical revision as an add-on therapy to standard debridement. In all cases, the wound was primarily closed without drains.ResultsWound healing was completed between 14 and 21 days after the second surgical revision in all patients. At a median follow-up of 8 months (range: 6 to 18 months), no recurrence of dSSI nor complications were encountered in any case.ConclusionsOur preliminary results suggest that PRF augmentation in persistent dSSI after instrumented spinal surgery appears to be a safe and effective strategy to promote wound healing. Prospective controlled studies are required to define the efficiency of PRF more clearly in both treating and preventing dSSI.
Highlights
Surgical wound healing is a complex process influenced by both exogenous and endogenous factors such as: length of the incision, surgical duration, pathogens’ colonization with pathogens, diabetes, smoking, local biology/vascularization and nutritional status [7]
This environment noticeably impairs cell-migration and proliferation leading to persistent Deep surgical site infections (dSSIs), in the presence of comorbidities interfering with the physiological wound healing [28]
The postoperative course after the second surgical revision with platelet-rich fibrin (PRF) augmentation was uneventful in every patient and completed wound healing was achieved between 14 and 21 days in all cases
Summary
Surgical wound healing is a complex process influenced by both exogenous and endogenous factors such as: length of the incision, surgical duration, pathogens’ colonization with pathogens, diabetes, smoking, local biology/vascularization (e.g. revision surgery, skin affected by radiotherapy) and nutritional status [7]. Reconstruction of paravertebral soft tissue and wound healing may be challenging after extensive debridement, since necrotized space fills with a mixture of fluid and wound debris (Fig. 1,1B). This environment noticeably impairs cell-migration and proliferation leading to persistent dSSI, in the presence of comorbidities interfering with the physiological wound healing [28]. Conclusions Our preliminary results suggest that PRF augmentation in persistent dSSI after instrumented spinal surgery appears to be a safe and effective strategy to promote wound healing. Prospective controlled studies are required to define the efficiency of PRF more clearly in both treating and preventing dSSI
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