References
Intra-soft tissue and intramedullary antibiotic perfusion in combination with negative pressure wound therapy
Abstract
Objective:
Intra-soft tissue and intramedullary antibiotic perfusion (iSAP and iMAP), which combine continuous administration of antibiotic solution to the wound and negative pressure wound therapy (NPWT), have been reported to be a useful management approach for hard-to-heal ulcers in the field of orthopaedic surgery. We report the efficacy of this treatment and discuss the key points.
Method:
The recipients of this treatment had contaminated fresh severe trauma with a high risk of infection, or hard-to-heal ulcers which were expected to be difficult to manage with conventional NPWT alone. Continuous administration of 1200µg/ml of gentamicin (GM) solution to the wound was performed along with NPWT. The GM solution was administered subcutaneously using a small catheter for iSAP, while intramedullary administration used a bone marrow needle for iMAP.
Results:
iSAP was employed in all 10 patients who took part, and iMAP in three of these patients. The average treatment time was 13.6 days with iSAP and 9.3 days with iMAP. The mean serum GM level during the therapy was 1.02µg/ml. Moderate GM-induced acute kidney injury was suspected in one case, but resolved spontaneously after GM administration was stopped. Favourable wound bed preparation was achieved in all cases without recurrence of infection.
Conclusion:
Combination with continuous suction by NPWT is able to keep the local concentration of antibiotic above the minimum inhibitory concentration of biofilm-coated bacteria within the wound. We have referred to this treatment as continuous local antibiotic perfusion. Further investigation of local pharmacodynamics in the wound and side-effects of this treatment are warranted.
Negative pressure wound therapy (NPWT) is a wound management method for hard-to-heal ulcers that cannot be healed with conventional care. This innovative wound care system promotes wound healing, which eventually results in a significant reduction in hospital stay and medical expenses.1 In recent years, the efficacy of NPWT has been confirmed for the management of acute wounds, such as severe open fractures.2 The indications for NPWT are expected to increase with developments in medical technology in the near future.
However, the potential risk of infection during treatment with NPWT must be kept in mind.3 The semi-closed space created by NPWT offers a comfortable environment for bacteria. Debridement of devitalised tissue is necessary for the prevention of infection during NPWT, but the time-lag between surgical debridement and the introduction of NPWT poses problems. The delay in the introduction of NPWT and subsequent reconstructive surgery leads to a significant use of medical resources and adversely affects the patient's quality of life.
Register now to continue reading
Thank you for visiting Journal of Wound Care's World Union of Wound Healing Supplement and reading some of our peer-reviewed resources for healthcare professionals. To read more, please register today.