Negative pressure therapy in the treatment of a traumatic fistula of glenohumeral joint with concurrent osteomyelitis and infection of periarticular tissues.
A negative pressure dressing system enables effective dressing of traumatic wounds. Extensive injuries and tissue defects that accompany bone fractures and articular surface injuries require special management. In case of compound fractures, the risk of bone, joint and soft tissue infection significantly increases, so the appropriate healing process of traumatic wound is limited. Undisturbed healing process of traumatic wound is conditioned only by the proper wound dressing process by the removal of necrotic and ischemic tissues and elimination of the sources of infection and infections themselves. The article shows a case report of a patient with a traumatic subcapital humerus fracture complicated by a haematoma and then by a periarticular abscess. After the incision and drainage of a reservoir of blood and pus, a chronic infected fistula of glenohumeral joint was formed. During a prolonged therapeutic process an aggressive surgical management was implemented, by the removal of the infected bone, what eliminated the actively secreting fistula of glenohumeral joint. Following the appropriate wound preparation, the negative pressure therapy was successfully applied. In the described case the application of negative pressure dressing system enabled a gradual decrease of total wound depth and surface area and consequently, a restriction of tissue defects.
Carek PJ, Dickerson LM, Sack JL. Diagnosis and management of osteomyelitis. Am Fam Physician 2001; 63: 2413-20.
Waldvogel FA, Medoff G, Swartz MN. Osteomyelitis: a review of clinical features, therapeutic considerations and unusual aspects. N Engl J Med 1970; 282: 198-206. doi:http://dx.doi.org/10.1016/j.cpm.2004.03.008
Lew DP, Waldvogel FA. Osteomyelitis. Lancet 2004; 364: 369-79. doi:10.1016/S0140-6736(04)16727-5
Cierny G, Mader JT, Pennick JJ. A clinical staging system for adult osteomyelitis. Contemp Orthop 1985; 10: 17-37. doi:10.1016/S0140-6736(04)17298-X
Esposito S, Leone S, Bassetti M, Borrè S, Leoncini F, Meani E, Venditti M, Mazzotta F; Bone Joint Infections Committee for the Italian Society of Infectious Tropical Diseases (SIMIT). Italian guidelines for the diagnosis and infectious disease management of osteomyelitis and prosthetic joint
infections in adults. Infection 2009; 37: 478-96. doi:10.1007/s15010-009-8269-2.
Coles CP, Gross M. Closed tibial shaft fractures: management and treatment complications. A review of the prospective literature. Can J Surg 2000; 43(4): 256-62.
Ron Rock MSN, RN, ACNS-BC; Wound Care Advisor, March/April 2014; http://woundcareadvisor.com/wp-content/uploads/ 2014/03/GUIDELINES_M-A14.pdf
Ballard K, Baxter H. Vacuum-assisted closure. Nurs Times 2001; 97: 51-52.
Kim PJ, Attinger CE, Steinberg JS, Evans KK. Negative pressure wound therapy with instillation: past, present, and future. Surg Technol Int. 2015 May; 26: 51-6.
Gupta S, Gabriel A, Lantis J, Téot L. Clinical recommendations and practical guide for negative pressure wound therapy with instillation. Int Wound J. 2015 May 23. doi: 10.1111/iwj.12452. [Epub ahead of print].
Kuehn F, Schiffmann L, Janisch F, Schwandner F, Alsfasser G, Gock M, Klar E. Surgical Endoscopic Vacuum Therapy for Defects of the Upper Gastrointestinal Tract. J Gastrointest Surg. 2015 Dec 7. [Epub ahead of print].
Smallwood NR, Fleshman JW, Leeds SG, Burdick JS. The use of endoluminal vacuum (E-Vac) therapy in the management of upper gastrointestinal leaks and perforations. Surg Endosc. 2015 Sep 30. [Epub ahead of print].
Jämsen E, Huhtala H, Puolakka T, Moilanen T. Risk factors for infection afterknee arthroplasty: a register-based analysis of 43,149 cases. J Bone Joint Surg Am 2009; 91(1): 38-47.
Peersman G, Laskin R, Davis J, Peterson M. Infection in total knee replacement: a retrospective review of 6489 total knee replacements. Clin Orthop Relat Res 2001; 392: 15-23. doi: 10.1007/s11420-005-0130-2
Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res 2008; 466: 1710-5. doi: 10.1007/s11999-008-0209-4. Epub 2008 Apr 18.
Lazzarini L, Mader JT, Calhoun JH. Osteomyelitis in long bones. J Bone Joint Surg Am 2004; 86 A: 2305-18. http://dx.doi.org/10.1590/S1413-86702010000300020
Weston V, Coakley G; British Society for Rheumatology (BSR) Standards, Guidelines and Audit Working Group; British Society for Antimicrobial Chemotherapy; British Orthopaedic Association; Royal College of General Practitioners; British Health Professionals in Rheumatology. Guideline for the management of the hot swollen joint in adults with a particular focus on septic arthritis. J Antimicrob Chemother 2006; 58: 492-3.
Coakley G, Mathews C, Field M, Jones A, Kingsley G, Walker D, Phillips M, Bradish C, McLachlan A, Mohammed R, Weston V; British Society for Rheumatology Standards, Guidelines and Audit Working Group. BSR & BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adults. Rheumatology (Oxford) 2006; 45: 1039-41. PMID:16829534 [PubMed - indexed for MEDLINE]
Sayed S, Prabhu S, Thomas M, McBride CA, Alphonso N. Ann Primary Sternal Osteomyelitis With Extensive Mediastinal Abscess in a Neonate. Thorac Surg. 2015 Oct; 100(4): e85-7. doi:10.1016/j.athoracsur.2015.05.133.
Akil A, Schnorr P, Wiebe K. Strategies for the treatment of postoperative sternal infections. Zentralbl Chir. 2015 Oct 22. [Epub ahead of print] German.
Chan M, Yusuf E, Giulieri S, Perrottet N, Von Segesser L, Borens O, Trampuz A. A retrospective study of deep sternal wound infections: clinical and microbiological characteristics, treatment, and risk factors for complications. Diagn Microbiol Infect Dis. 2015 Nov 14. pii: S0732-8893(15)00410-1. doi: 10.1016/j.diagmicrobio.2015.11.011. [Epub ahead of print].
Liu G, Pan SP, Chen XP. Vacuum sealing drainage for the treatment of in postoperative wound disunion after calcaneal fracture. Zhongguo Gu Shang. 2012 Sep; 25(9): 782-4. Chinese.
Du Q, Cong H, Shi Y, Jiang H, Sui H. Treatment of tibial traumatic osteomyelitis with vacuum sealing drainage combined with open bone graft. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2014; 28(5): 562-5. Chinese.
Tan Y, Wang X, Li H, Zheng Q, Li J, Feng G, Pan Z. The clinical efficacy of the vacuum-assisted closure therapy in the management of adult osteomyelitis. Arch Orthop Trauma Surg. 2011; 131(2): 255-9. doi: 10.1007/s00402-010-1197-x. Epub 2010 Dec 23.
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