Facial trauma is often associated with soft tissue defects and bacterial contamination which pose significant challenges to reconstruction, especially after conventional intravenous antibiotics and advanced dressings have failed to stabilize the wound.
We describe a 42 year old attractive woman who suffered a full thickness contaminated left cheek wound after surgical closed reduction of a left sided zygomatic arch fracture. Daily Closed Pulse Irrigation* Wound Therapy (CPI* WT) was used to successfully manage a, 3.0 cm x 3.2 cm, tunneling full thickness facial wound with persistent Methicillin-Resistant Staphylococcus Aureus (MRSA) infection and periorbital cellulitis.
CPI* WT is a new anti-biofilm strategy, which allows daily selective mechanical debridement (15 psi, low pressure water-jet ) within a portable/disposable system providing safety through total containment. CPI* WT was shown to stimulate healthy granulation and epithelialization of a heavily MRSA contaminated facial wound, resulting in complete healing by secondary intention with minimal scarring. This case demonstrates that CPI* WT can be performed on a facial wound to decrease bio-burden which promotes resolution of wound sepsis and cellulitis while providing an acceptable cosmetic and functional result, as preparation for minor scar revision and/or fat grafting. CPI* WT is a novel alternative to other advanced wound care modalities including serial OR debridement, skin grafting and flap reconstruction often associated with permanent facial scarring.
The clinical results show that CPI* WT can selectively debride and reduce bio-burden of a tunnelling facial wound while preserving skin, soft tissue, muscular, neurological and vascular structures. CPI® WT provides a safe and effective facial reconstructive option in conjunction with minor scar revision and fat grafting, for these challenging cases with a high level of patient satisfaction.
Product Notation*: Closed Pulse irrigation® (CPI®), PulseCare Medical LLC, North Andover, Massachusetts.