Vacuum Sealing Drainage against surgical site infection after intracranial neurosurgery: a technical note

Abstract Background: Surgical site infections (SSIs)are still a challenge to neurosurgeons. However, Vacuum Sealing Drainage (VSD), which has been used extensively in the treatment of various infections after surgery, looks a promising solution. This study examines the efficacy and outcome of VSD treatment of pyogenic SSIs following intracranial neurosurgery. Methods: 20 patients with infections who underwent surgical intervention were treated retrospectively using VSD at the Zhongnan hospital of Wuhan University over the past five years. Primary surgery types, SSI types, VSD replacements, surgical procedures, pathogenic germs, antibiotic therapy and infection control were reviewed and discussed. Results: Of the 20 infections, 13 (65%) were extradural, and 7 (35%) were extradural SSIs combined with intracranial infections (including 5 meningitis, 1 subdural abscess, and 1 brain abscess). All the patients consented to medical device implantation (including 5 titanium webs, 6 bone flap fixation devices and 12 dura-plasties), with most of the devices removed during debridement. The median duration from primary surgery to a SSI diagnosis was 19 days (range: 7 to 365 days). All the patients also agreed to debridement and VSD treatment; VSD was replaced 0 to 5 times (median, one time) every 4 to 7 days and retained for 4 to 35 days (median, 14 days). Seven (35%) patients had defined bacterial infections, with staphylococcus aureus the dominant infection. The deployed standard VSD and antibiotic treatment ensured full recovery from SSIs, including from intracranial infections: 14 (70%) patients were free of infection during follow-up, and no infection-associated death was registered; 6 (30%) patients died of severe primary affections. Conclusion: VSD-assisted therapy is safe and effective against SSIs after intracranial neurosurgery.