OPERATIVE MANAGEMENT OF SPINAL WOUND COMPLICATIONS OVER A THREE-YEAR PERIOD AT THE NATIONAL SPINAL INJURIES UNIT

Introduction Wound breakdown and infection after spinal surgery can cause significant morbidity, often requiring multidisciplinary management and prolonged hospitalization. Aims This study aims to quantify and characterise all operatively managed wound issues managed at the National Spinal Injuries Unit for Ireland, over a 3-year period, and identify factors which predicted Plastic Surgery involvement. Methods Data was collected relating to operatively managed spinal wound complications in a tertiary referral centre for spinal surgery between 2022 and 2024 inclusive. Patient demographics, comorbidity, operative factors, antibiotic use, microbiological cultures, and outcomes were examined. Univariate and multivariate logistic regression was used to model the likelihood of Plastic Surgery involvement. Results In total, 101 patients had 156 procedures for wound breakdown. Most patients had an initial spinal instrumentation for degenerative disease ( n =65, 69.9%). The mean time from the index spinal procedure to the first wound washout was 7.32 weeks (SD = 19.10 weeks), with the range varying between 0 to 156 weeks. Most spinal washouts were for wound dehiscence ( n =67), followed by a dural tear/CSF leak in 17 patients. Microorganisms were cultured in 71 cases, but the number and sample types varied. Of these, 41 patients (56.9%) grew a single organism, and 30 patients (42.2%) grew multiple organisms. Plastic Surgery was consulted in 8.9% of all cases ( n =9). A flap reconstruction was used in all of these cases. The involvement of Plastic Surgery was associated with peripheral vascular disease (p=0.016), longer operative time of the index case (p=0.019) and an increased number of wound washouts (p=0.001). Conclusions The management of spinal wound breakdowns is complex and multidisciplinary. This study furthers our understanding of which patients may benefit from early Plastic Surgery input and flap reconstruction.