Evaluating Negative Pressure Wound Therapy With Instillation and Dwell to Cleanse Surgical Wounds With Infection Post Open Reduction and Internal Fixation

Abstract

Internal fixation devices are important orthopedic hardware for bone consolidation following traumatic, open, lower extremity fractures.1,2 Orthopedic wound infections status post (s/p) open reduction and internal fixation (ORIF) are a significant complication and indicator of morbidity. Orthopedic hardware removal and surgical revision is costly and incurs additional time in the operating theater. Effectively cleansing an infected surgical orthopedic wound using negative pressure wound therapy with instillation and dwell time (*NPWTi-d) may be a practical intervention. Here, four patients (n = 4) with wound infections s/p ORIF for traumatic open lower extremity fractures were managed using NPWTi-d. Wound tissue culture was obtained and microbial assays performed. To treat the infection, antibiotics were administered per culture sensitivity reports. Debridement was performed as needed. To facilitate wound cleansing, NPWTi-d was initiated, with 1/8 strength Dakin’s Solution (NaOCl; sodium hypochlorite) to saturate the wound for 10 minutes followed by 2 hours of subatmospheric pressure (-125 mmHg). Dressing changes occurred every 3 days. NPWTi-d duration was 3 to 24 days. NPWTi-d was discontinued upon the patient achieving the therapeutic goal of a clean wound. Post culture assays ascertained no growth. The cleansed wounds were prepared for lower extremity reconstruction using either free tissue (muscle; n = 3) or local tissue (fascia cutaneous; n = 1). Full healing (90-day outcome) was noted in 100% of patients at the follow-up appointment with no need for hardware removal. In these patients, NPWTi-d was effective in cleansing post ORIF surgical wounds with infections and helped to prepare the wound for reconstruction surgery.

*V.A.C. VERAFLO™ Therapy (KCI, now part of 3M)

References

  1. McKissack HM, Viner GC, Jha AJ, Wilson JT, Anderson MC, McGwin G Jr, Shah AB. Comparison of risk factors for postoperative complications across age groups in patients undergoing ORIF of the ankle. Injury. 2019 Nov;50(11):2116-2122. doi: 10.1016/j.injury.2019.09.014. Epub 2019 Sep 12. PMID: 31547967.
  2. Okelana AB, McMillan LJ, Kibble K, Parikh HR, Gorman C, Schaefbauer H, Cunningham BP. Variation in Implant Selection for Ankle Fractures: Identifying Cost Drivers. J Orthop Trauma. 2019 Nov;33 Suppl 7:S26-S31. doi: 10.1097/BOT.0000000000001623. PMID: 31596781.

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