Comparison of a biological approach and negative pressure wound therapy to posterior spinous fusion internal wound dehiscence

Internal wound dehiscence is a difficult post surgical management problem following posterior spinous approach to fusion.  The problem of exposed bone and hardware in an area of limited tissue can be challenging especially in the patient with co-morbidities.  Frequently, these cases are managed with negative pressure wound therapy in an attempt to generate granulation tissue over the exposed bone and hardware.  The following study is a retrospective analysis of several cases to illustrate the comparative results between negative pressure wound therapy and a biological approach combining platelet rich plasma followed by xenografting of post-operative wound dehiscence in the setting of a posterior approach to spinous fusion.  Two patients were treated with negative pressure wound therapy and two patients were treated with a biological technique in a private long term acute care hospital.  The wound volumes of the patients treated with negative pressure wound therapy revealed less healing than the wounds treated with plasma and xenografting.  While this study represents an uncontrolled comparison of two different approaches to a difficult post-surgical problem, a biologic approach may provide superior wound healing.