CASE REPORT: Two cases were treated with NPWTi-d. Because of difficulties disrupting the deep dead space biofilm in a deep post-
fracture fixation SSI (and because of the risk for bone
infection), a double-lumen tube was used for subcutaneous
antibiotic perfusion and dead space
suction drainage, and bone marrow needles were used for intramedullary
antibiotic perfusion to manage or prevent early
osteomyelitis. The 2 patients with severe SSI after below-
knee fracture fixation were treated with continuous intramedullary and subcutaneous
antibiotic perfusion with NPWT to salvage the orthopedic implant. The debrided
wounds of the lower leg and heel were reconstructed with
free flaps and incisional NPWT, followed by administration of continuous intramedullary and subcutaneous
antibiotic perfusion to preserve the
titanium plates. In both patients, the
wounds healed without complications and remained healed after more than 7 months.
CONCLUSIONS: Continuous local
antibiotic perfusion around infected orthopedic fixation hardware can be an ideal treatment for patients with SSI after
fracture fixation. Although this technique can be improved further, it is more effective than conventional
therapy in the management of severe post-
fracture fixation SSI with a dead space.