Wound infection after spinal fusion in children with cerebral palsy

One hundred and seventy-two children with cerebral palsy were operated on f or neuromuscular scoliosis by spinal fusion with unit rod instrumentation b etween January 1988 and June 1996. There were 15 (8.7%) postoperative wound infections (seven deep, eight superficial) in 15 patients (five males, 10 females) who had a mean age of 13.9 years. The mean follow-up after diagnos is of infection was 3.3 years (range, 1-7.2). Twelve of the 15 infected cas es, including all seven deep infections, occurred in the distal portion of the incision. In 14 patients, the wound infections were diagnosed within th e first 2 months of the original spinal fusion. All the superficial wound i nfections were treated successfully by local wound care and intravenous ant ibiotics. The removal of hardware was necessary in the one late deep wound infection that occurred 2 years after the spinal fusion. The remaining six deep infections were treated by irrigation and debridement with the wound l eft open, allowing it to heal by secondary intention. One patient's wound w as closed over suction-irrigation drains; however, due to a recurrent absce ss, the wound was reopened and allowed to granulate. All the wound infectio ns occurred in severely neurologically involved spastic quadriplegics who w ere nonambulatory and severely mentally retarded and had seizure disorders.