Autologous Platelet-Rich Fibrin Therapy Enhances Healing in Deep Spinal SSIs

Overview

Deep surgical site infections (dSSIs) after instrumented spinal surgery pose significant treatment challenges, especially when traditional approaches fail. This case series demonstrates that autologous platelet-rich fibrin (PRF) augmentation, used as an adjunct to surgical debridement and antibiotics, promotes wound healing and infection resolution in persistent dSSIs.

Background

Postoperative spinal infections occur in up to 12% of cases, with deep SSIs involving subfascial tissues and often associated with metal implants. Standard management includes extensive debridement, drains, and targeted antibiotics, but persistent infections and soft tissue defects remain problematic. PRF, an autologous fibrin matrix rich in growth factors and leukocytes, has shown promise in enhancing wound healing and antimicrobial protection in various surgical fields. This study explores PRF's potential to improve outcomes in refractory deep spinal infections.

Data Highlights

Key Findings

• Deep SSIs occurred in 7% of instrumented spinal surgeries, with 60% of these infections persisting despite standard surgical revision and antibiotics.
• Autologous PRF was prepared intraoperatively from 120 ml of patient blood using a low-speed centrifugation protocol to concentrate growth factors and leukocytes.
• PRF augmentation was applied as both solid and injectable forms during a second surgical revision after renewed debridement.
• PRF's biological properties potentially enhance wound healing by promoting cell migration, proliferation, and providing local antimicrobial effects.
• PRF therapy was successfully used in patients with persistent dSSIs involving titanium implants and complex tissue defects.
• The procedure was feasible across cervical, thoracic, and lumbar spine levels, including minimally invasive approaches.

Clinical Implications

Incorporating autologous PRF as an adjunctive therapy in persistent deep spinal infections may improve wound healing outcomes where conventional treatments fail. The ease of preparation and application during surgical revision supports its integration into clinical practice for managing complex dSSIs, especially in the presence of spinal instrumentation.

Conclusion

Autologous platelet-rich fibrin augmentation represents a promising strategy to enhance healing in refractory deep surgical site infections following instrumented spinal surgery. Further studies are warranted to validate these initial encouraging results.

References

1. Choukroun & Ghanaati 2018 -- Low centrifugation concept protocol for PRF preparation
2. CDC 2017 -- Classification of surgical site infections
3. Various Authors 2019 -- PRF applications in wound healing and infection control