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INTRODUCTION
A 42 year old male employed at the local racetrack admitted to acute care after a horse stepped on his foot. Though x-rays were negative, CT identified a multi-focal pyomositis with MRSA resulting in a necrotizing infection, abscesses to bilateral arms, shoulder, back, right thigh, calf, knee, septic emboli, high grade bacteremia. He has multiple comorbidites including poorly controlled diabetes, heavy alcohol consumption and unknown substances. Initial wound care was performed daily under anesthesia lasting up to two hours.
Once wounds were free of frank purulence, wound care was initiated on the acute care unit using Polyvinyl alcohol (PVA) with Methylene blue and Gentian Violet.
METHODOLOGY
Prevent recurrent systemic infection, ease of dressing changes, and minimize pain were very important goals. Wound dressings were twice a week on the 5 body sites using bacteriostatic foam composed of polyvinyl alcohol (PC-PVA) with Methylene blue and Gentian Violet (pigment-complexed PVA sponge) in tampon form. Negative pressure wound therapy was applied to all five wounds.
RESULTS
No signs of acute infection. Beefy red granulation tissue was developing. Wound cultures were negative for MRSA. Pain at dressing change decreased from a 10 on IV medications to 2 on oral pain medication. Patient was prepared for transfer to long term care facility.
CONCLUSION
The use of bacteriostatic PC-PVA sponge in combination with NPWT allowed these complex wounds to clear deep MRSA infection and prevent premature tunnel closure of the wounds.
A 42 year old male employed at the local racetrack admitted to acute care after a horse stepped on his foot. Though x-rays were negative, CT identified a multi-focal pyomositis with MRSA resulting in a necrotizing infection, abscesses to bilateral arms, shoulder, back, right thigh, calf, knee, septic emboli, high grade bacteremia. He has multiple comorbidites including poorly controlled diabetes, heavy alcohol consumption and unknown substances. Initial wound care was performed daily under anesthesia lasting up to two hours.
Once wounds were free of frank purulence, wound care was initiated on the acute care unit using Polyvinyl alcohol (PVA) with Methylene blue and Gentian Violet.
METHODOLOGY
Prevent recurrent systemic infection, ease of dressing changes, and minimize pain were very important goals. Wound dressings were twice a week on the 5 body sites using bacteriostatic foam composed of polyvinyl alcohol (PC-PVA) with Methylene blue and Gentian Violet (pigment-complexed PVA sponge) in tampon form. Negative pressure wound therapy was applied to all five wounds.
RESULTS
No signs of acute infection. Beefy red granulation tissue was developing. Wound cultures were negative for MRSA. Pain at dressing change decreased from a 10 on IV medications to 2 on oral pain medication. Patient was prepared for transfer to long term care facility.
CONCLUSION
The use of bacteriostatic PC-PVA sponge in combination with NPWT allowed these complex wounds to clear deep MRSA infection and prevent premature tunnel closure of the wounds.