Do Dose-Dependent Microbial Changes Occur during Spine Surgery as a Result of Applying Intrawound Vancomycin Powder?: A Systematic Literature Review

We analyzed dose-dependent effects of vancomycin on wound infection bacteria and investigated the relationship between dose and microbial imbalances in patients treated with intrawound vancomycin powder during spine surgery. Numerous trials have confirmed that using intrawound vancomycin powder during spine surgery may decrease postoperative wound infection rates. However, potential risks include changes in wound infection bacteria, inhibition of bone fusion, and systemic toxicity. We searched PubMed for articles published since October 2016 with the following terms: “local vancomycin” or “intrawound vancomycin” or “intraoperative vancomycin” or “intrawound vancomycin” or “topical vancomycin” and “spinal surgery” or “spine surgery.” We also screened the reference lists of included articles for additional studies and extracted data related to dose, infecting bacteria, sample size, infection rate and types, location of spine surgery, and perioperative antibiotics used. Our review includes one prospective and nine retrospective studies. Overall, 1 or 2 g local vancomycin powder was used in 2,394 patients. Gram-negative bacteria were dominant in patients in whom 1 g vancomycin powder was used, whereas gram-positive bacteria were dominant in those in whom 2 g powder was used. The exact mechanism underlying this dose-dependent trend remains unclear, although it may be attributed to the pharmacological characteristics of vancomycin. The included studies showed that trends in infection bacteria may change after the use of topical vancomycin powder. In addition, the observed increase in gram-negative bacteria when intrawound vancomycin powder is used has generated considerable attention. The present results differ from previous results but do not provide additional information regarding vancomycin dose and microbial changes in infected wounds. Additional large randomized controlled trials are needed to determine the relationship between vancomycin dose and the types of wound infection bacteria in patients treated with intrawound vancomycin powder during spine surgery.

Distally based perforator-plus sural fasciocutaneous flap for repair of lower leg soft-tissue defects in pediatrics and adults / 中华创伤杂志

Objective To compare the effect of distally based perforator-plus sural fasciocutaneous flap for soft tissue reconstruction of the lower leg in pediatric and adult populations.Methods Data of 165 patients treated with distally based perforator-plus sural fasciocutaneous flap between April 2001 and February 2011 were retrospectively reviewed.There were 125 males and 40 females,at age range of 3-78 years.The patients were divided into pediatric group (＜ 14 years,n =50) and adult group (≥ 17 years,n =115) according to the age.The two groups were compared in terms of flap-viability-related complications (partial necrosis,marginal necrosis and overall complication rate) and their potential risk factors (sex,location of defect,causes of defect,pivot point site and top-edge location).For the patients followed at least 12 months,the reconstruction outcomes,donor-site morbidities(hypertrophic scar,pruritus,pigmentation,numbness of skin graft area and paresthesia of skin graft area),and swelling of the limb were compared between the groups.Results All patients were followed up for 2 weeks to 72 months.Partial necrosis of the flap,marginal necrosis of the flap,and overall complications in pediatric group accounted for 14％,4％ and 18％ respectively,higher than 11.3％,1.7％ and 13.0％ in adult group,but the differences were insignificant (P ＞ 0.05).Sex ratio,pivot point site and top-edge location were not significantly different between the groups (P ＞ 0.05).Pediatric group versus adult group presented a significantly lower proportion of pretibial defects,but significantly higher proportions of the defects over the achilles tendon and heel (P ＜ 0.05).A significantly higher proportion of spoke injury and lower proportions of tamp injury and sports injury were observed in pediatric group than in adult group (P ＜0.05).Reconstruction outcomes were not significantly different between the groups (P ＞ 0.05).Pediatric group versus adult group presented significantly higher incidences of hypertrophic scar and pruritus at the donor site,but a significantly lower incidence of limb swelling (P ＜ 0.05).Conclusion Reliability and repair effect of the distally based perforator-plus sural fasciocutaneous flap are similar between pediatrics and adults,while the pediatrics are more likely to have hypertrophic scar and pruritus at the flap donor site.

Effect of length-width ratio on partial necrosis in distally based sural neurofasciocutaneous flap: 157 cases / 中南大学学报(医学版)

OBJECTIVE@#To explore the effect of length-width ratio (LWR)on partial necrosis in distally based sural neurofasciocutaneous flap.@*METHODS@#Clinical data and operative pictures of 157 distally based sural neurofasciocutaneous flaps were reviewed and analysed. LWR of the flaps ranged from 2.83:1 to 7.14:1. Based on the LWR of the flaps, the flaps were divided into 5 groups: Group A(LWR≤3:1), Group B(3:10.05). Partial necrosis ratio was higher in Group D than that in Group C(P<0.05). It was lower in the LWR<5:1 group (Group A+Group B+Group C) (6.8%, 6/88) than that in the LWR≥5:1 group (Group D+Group E) (17.4%, 12/69) (P<0.05).@*CONCLUSION@#When LWR of the flap is less than 5:1, probability of partial necrosis occurring in distally based sural neurofasciocutaneous flaps is low, and the flap can survive more reliably. The maximum LWR of the surrival flaps can reach 6-7:1.