Multicenter retrospective review.
To compare the incidence of infection between vertical expandable prosthetic titanium rib
locations and determine if the infection risk increases in relation to presence of previous incisions and/or increased number of times incisions are opened.
Summary of Background Data.
Patients undergoing treatment for chest and spine deformity with VEPTR
require multiple incisions that are opened repeatedly during expansion procedures.
A prospective database (7 sites) and institutional database (2 sites), were queried to identify their 20 most recent patients with VEPTR
with a minimum of 4 expansions for inclusion. A total of 103 patients were identified. Clinical and operative reports were reviewed to determine incision
locations, number, and infection complications
Twenty-five of 103 patients (24%) developed an infection during treatment. Six had multiple infections (range, 2–4), providing a total of 34 infection events. Patients averaged 6.4 expansion procedures and 13 total incisions. Infection rate
at each incision
site was not significantly different, in the range from 1% to 5%: paramedian (6 infections/23 patients with total 185 incisions, 3%), proximal midline (12/39; 224, 5%), thoracotomy (6/61; 455, 1%), iliac (5/37; 143, 4%), and distal midline (5/58; 148, 3%). Infection events occurred after an average of 3 times a particular incision
was opened (95% confidence interval: 2.2–3.8). There was a trend toward higher infection rate
with increased number of times a particular incision
was opened. There was no increased infection rate
in patients with surgical incisions prior to VEPTR
(26%; 6/23) compared with patients not having prior incisions (24%; 19/80).
The incidence of infection in patients with 4 or more VEPTR
lengthenings was 24% and did not differ across the various incision
locations. Presence of prior surgical incisions was not a risk factor for infection. Surgeons should use the most appropriate incision
in relation to their patient's pathology when using VEPTR
while remaining vigilant for infection.
Level of Evidence: 3