Local treatment of infections in neurosurgery with gentamicin PMMA chains (Septopal)

Abstract

Treatment of infections after neurosurgical operations at the head and vertebral column is lengthy and stressful for the patient. Hence, we implanted--as has been routine in septic bone surgery for a long time--carriers of antibiotics for local antibiotic therapy in the form of Septopal chains. The course of treatment and the results obtained in 16 patients are presented. In all patients the wound cavities were filled with Septopal chains after débridement. In the course of 6-12 days the chains projecting from the skin by a stab incision were extracted sphere by sphere. The treated wound healed immediately in 14 patients; healing was delayed in 2 patients, but there were no complications. Since the use of Septopal chains results in local gentamicin levels which are so high that the conventional classification of germs into gentamicin-sensitive/gentamicin-resistant is of minor importance, the wounds healed without complications even in those patients where the germs had been classified as "resistant" in the routine antibiogram. Thus, Septopal offers the advantage of primary wound closure without secondary contamination or scatter into the environment (intensive-care ward!), shorter treatment time, reduced stress for the patient and more rapid mobilisation.