Autologous platelet-rich fibrin (PRF) augmentation as an add-on therapy in deep surgical site infections (dSSIs) after instrumented spinal surgery: preliminary results of a single institution case series - Scorecard - MDSpire
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Autologous platelet-rich fibrin (PRF) augmentation as an add-on therapy in deep surgical site infections (dSSIs) after instrumented spinal surgery: preliminary results of a single institution case series
Clinical Scorecard: Enhancing Healing in Deep Surgical Site Infections Post-Instrumented Spinal Surgery: Initial Findings from a Case Series on Autologous Platelet-Rich Fibrin (PRF) Therapy
At a Glance
Category
Detail
Condition
Deep surgical site infections (dSSIs) after instrumented spinal surgery
Key Mechanisms
Impaired wound healing due to tissue necrosis, fluid accumulation, and comorbidities; PRF provides growth factors, chemokines, leukocytes enhancing healing and antimicrobial protection
Target Population
Patients with persistent deep spinal surgical site infections unresponsive to standard surgical debridement and antibiotic therapy
Care Setting
Surgical and postoperative care in spinal surgery departments
Key Highlights
Deep SSIs occur in up to 7% of spinal surgery patients and are challenging to treat due to tissue defects and impaired healing.
Standard treatment includes extensive debridement, drains, and targeted antibiotics, but some cases remain persistent.
Autologous platelet-rich fibrin (PRF) augmentation as an add-on therapy shows promise in enhancing wound healing in persistent dSSIs.
Guideline-Based Recommendations
Diagnosis
Confirm deep SSI by contrast-enhanced MRI and laboratory tests (blood cell counts, ESR, CRP).
Identify pathogens via wound swabs and blood cultures.
Management
Perform extended surgical debridement preserving metalwork when possible.
Administer intravenous pathogen-specific antibiotic therapy.
Use antimicrobial moisture-retentive dressings and vacuum therapies if primary closure is not possible.
Consider autologous PRF augmentation after failure of standard treatment.
Monitoring & Follow-up
Monitor clinical signs, laboratory markers, and radiological assessments during follow-up.
Remove surgical drains when drainage is less than 50 ml/day.
Risks
Persistent infection leading to wound dehiscence and soft tissue defects.
Potential dural tears during revision surgery (noted in 41.7% of cases).
Patient & Prescribing Data
12 patients with persistent deep SSIs after spinal instrumentation unresponsive to initial debridement and antibiotics
PRF prepared from 120 ml autologous blood using low-speed centrifugation; applied as solid and injectable forms during second surgical revision to augment tissue defects.
Clinical Best Practices
Use prophylactic antibiotics (Cefuroxime or Clindamycin) perioperatively according to allergy status.
Perform meticulous surgical debridement preserving spinal implants when possible.
Prepare PRF intraoperatively using standardized low-speed centrifugation protocols to maximize growth factor concentration.
Apply PRF augmentation during second revision surgery for persistent dSSI to promote healing and antimicrobial effects.
by Ioannis Vasilikos, Roland Roelz, Christoph Scholz, Boris Mizaikoff, Katerina Argiti, Watzlawick Ralf, Georgios-Christos Giagkos, Evangelos M. Fragkakis, Shahram Ghanaati, Jürgen Beck, Ulrich Hubbe
Two patients presented months after minimally invasive facial procedures with persistent findings that ultimately revealed retained foreign bodies, according to a recent case series.
