40 yr old female with history of chronic back pain and obesity. Underwent lumbar laminectomy and
then multiple revisions for surgical site infections. Prior to admission to LTAC had multiple
complications with outpatient treatment including PICC infections and repeat ER visits for
irretractible pain. Lumbar wound with multiple surgeries to area for infected hardware and finally
removal of hardware on Dec 5 2010 with I & D of lumbar area. Lumbar wound left open to heal by
secondary intention due to concern for infection and scar tissue. All cultures negative from multiple
surgeries except original cultures of area noted to be MSSA. Lumbar fluid negative for beta 2
transferrin. Admitted to LTAC after last surgery for wound care, IV antibiotics and pain
management. Negative Pressure Wound Therapy continued to area with serial debridements to
remove nonviable tissue. MRSE cultured from wound 12
-27 but thought to be possible
contaminant. After wound bed preparation, PRP applied to wound bed 12
-29
-10. Local dressing
care with nonadhering adaptic and telfa with gauze utilized post procedure with VAC on hold.
Delayed secondary closure in staged manner to lumbar area. Wound continued to drain slightly
but patient requested complete closure prior to discharge from hospital. Staged closure done on
1/12/11 to proximal, 1/19/11mid portion and to complete the closure 1/26/11. D