Management of wound complications in spinal surgery

Wound complications after spinal surgery are relatively uncommon; however, they can be associated with a significant amount of morbidity. Wound breakdown after spinal surgery is due to a wide variety of causes, ranging from the trivial to life threatening. Prevention and appropriate management of wound complications is of utmost importance. Various studies report rates of wound complications ranging from 1.9% (Weinstein et al, 2000) to 20% (Klink et al, 1994). Sequelae associated with wound infection include prolonged length of hospital stay, multiple operations, meningitis, pseudoarthrosis, osteomyelitis, and loss of hardware. Spinal surgery is unique in its reliance on high-profile hardware for correction of defects. Loss of hardware is equivalent to ultimate failure of the procedure. Incidence of wound complication can be decreased through several preoperative and intraoperative strategies. Salvage of hardware is crucial in the event of wound complication. Important principles in management of wound complication are early detection, adequate debridement, and muscle flap coverage of hardware. In this paper, we address predisposing factors for wound complications, steps that can be taken to minimize risk of infection at time of operation, and management of wound complications once they occur.