Hardware Salvage Using Negative Pressure Wound Therapy with Instillation

Complex orthopedic wounds with hardware involvement are at risk for serious complications, such as impaired function, restricted mobility or bone loss (Lehner, Fleischmann, Becker, &  Jukema, 2011). Othopedic patients who develop postoperative implant complications, wound dehiscence or infections, are limited in treatment options. Standard therapy commonly recommends surgical debridement with use of systemic antibiotic therapy, one versus two stage replacement or removal of implant without replacement (Lehner, et al., 2011). Using an innovative approach to hardware salvage several patients had positive outcomes in a community hospital.

Intermittent negative pressure wound therapy with instillation (NPWTi) was implemented in four patient scenarios. A mixture of topical antimicrobial solution was used to bathe wound bed and hardware involved. Instillation volume, soak time and negative pressure therapy time was determined based on wound location, size, and complexity.

Case #1: patient presented with soft tissue infection of left lower extremity with exposed hardware status post Schatzker 5/6 tibial plateau fracture.

Case #2: patient presented with one week non healing surgical wound in lumbar spine hemilaminectomy, L4-L5 laminectomy, multiple facetectomies L3-S1 fusion with

master graft matrix and L3-S1 pedicle screw rod system.

Case #3: patient presented with three week postoperative cervical spine non-healing surgical wound status post laminectomy with decompression of the spinal cord and nerve roots including all medial facetectomies and foraminotomies with hardware placement.

Case #4: patient presented with non-healing surgical wound status post repair of tibial fracture with history of internal hardware of right lower extremity with known osteomyelitis.

Negative pressure wound therapy with instillation complemented standard of care for orthopedic wound complications. This treatment modality prevented loss of limb, increased patient function and increased patient satisfaction in the four case scenarios.