Treatment of Hardware Infection after Osteosynthesis of Lower Leg using Negative Pressure Wound Therapy and Transforming Powder Dressing

Marin Marinović, Aldo Ivančić, Josip Španjol, Maja Pin, Bore Bakota, Ante Bandalović, Fabijan Čukelj

Abstract


Fractures of the distal part of the lower leg are more common in everyday practice and traumatology. In young and active patients these injuries are mainly caused by high energy trauma. They are treated with external fixator in first step, and in second step, after sanation of the soft tissue, with open reduction and internal fixation (ORIF). It is very safe and effective method of treatment. Treatment of the infections that occur in the early postoperative period after open reduction and internal fixation represents a great problem and challenge for surgeons. It is widely accepted that the presence of deep infection can´t be cured in the presence of hardware. However, removal of hardware in the presence of unhealed fractures significantly complicates sanation of  infection and fracture itself.We have decided to present a 35-years-old patient with a hardware infection with present chronic wound with hardware exposed eight months after the first operation and six months after second operation. The wound measured one centimeter in diameter with cell detritus and bad granulations tissue inside the wound. Hardwre was exposed in the depth of the wound .The secretion was minimal.Negative Pressure Wound Therapy (NPWT) was applicated after debridemet and lavage performed in ambulatory conditions. The starting therapy was continuously –125 mm Hg of vacuum. After five days of NPWT the defect was partially filled with granulation tissue. For another five days we continue with NPWT with the same values of -125 mm Hg pressure but in the intermitent mode. After that period we used transforming powder dressing for covering and protection of the wound with was filled with granulation tissue. Five days later, wound was completely healed with epithelisation. After four months of patient follow-up, we found the wound is completely repaired. The patient denies pain and has continued orderly flow of fracture healing, with no signs of infection.


Keywords*


hardware infection, NPWT, transforming powder dressing, lower leg fracture

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