VAC Irrigation - Treatment for Infected Wounds with Metalwork Present
Current infection rate in orthopaedic trauma is between 1-5%, depending on extensity of injury, length of procedure and soft tissue and bone damage during the surgery but also during the injury.
When infection happens it is well known that chances for success depends on time since infection became apparent, extension of infection into the bone and soft tissue, stability of fractured bone fixation. First washout is usually followed by further washouts and application of VAC dressing to the wound. VAC dressing will increase granulation tissue formation but also removal of necrotic tissue to the extent. Relying on VAC dressing to do the job in form of adequate debridement usually fails and causes further spread of infection and prolongs the treatment.
If infections of soft tissues, bone and metalwork are not appropriately treated patient is exposed to significant risk of turning current infection into life time infection with failed metalwork fixation which inevitable leads to significant deterioration of patient’s condition and can end in amputation of affected limb.
Infection in lower leg is very difficult to treat and can leave patient with long term infection called chronic osteomyelitis. It represents with periods of remissions, which can last from fem months to many years and periods of reactivation. Reactivation periods are very difficult to manage and are unpredictable. We still have to opt for amputation in ceases of protracted and uncontrollable infection.
My current experiences with infected metalwork are described in the article(1) we published in 2013 in Annals of Royal College of Surgeons. In Addenbrookes I treated 9 patients in 18 months and managed to recreate the same results.
If treatment is delivered promptly, meticulously and at least throughout two weeks chances for success are extremely high, close to 100%.
Advantages of my treatment comparing to the standard VAC technique are:
Advantages of the procedure
1. Norris, R., Chapman, a W. P., Krikler, S. & Krkovic, M. A novel technique for the treatment of infected metalwork in orthopaedic patients using skin closure over irrigated negative pressure wound therapy dressings. Ann. R. Coll. Surg. Engl. 95, 118–24 (2013).