Successful treatment of infected wound dehiscence after minimally invasive locking-plate osteosynthesis of tibial pilon and calcaneal fractures by plate preservation, surgical debridement and antibiotics.

OBJECTIVE: The aim is to present a case series that illustrates possible benefits from combining minimally invasive plate osteosynthesis (MIPO), plastic surgery and antibiotic therapy, in order to treat and eradicate infection in patients with tibial pilon or calcaneal fractures. METHODS: Eleven consecutive patients with dehiscence of the surgical wound in outcomes MIPO using a Locking Compression Plate (LCP) for tibial pilon, or calcaneus fractures. The patients had developed a documented infection of the surgical wound. All patients were treated and followed-up by the multidisciplinary team with the orthopedic surgeon, the plastic surgeon and the infectious disease physician. All patients were followed by the plastic surgeon to treat the wound dehiscence, as well as by the orthopedic surgeon until fracture consolidation. The duration of the antibiotic therapy was from 4 to 6 months. After 6 weeks, the intravenous treatment was replaced by oral administration. The follow-up intervals were 15 days, 40 days, and 3 months. RESULTS: The average time of wound closure was 109±60 days. The antibiotics used were chosen according to the antibiogram. The antibiotic therapy had a duration of 4-6 months, and after 6 weeks, the therapy switched to oral administration. At the 3-month follow-up, all patients had excellent outcomes and had returned to their normal activity of daily living. CONCLUSION: The patients in this study responded positively to a combination of MIPO, plastic surgery and antibiotic therapy, confirming that multidisplinary treatment in association with titanium devices are able to eradicate infection in short time.

Soft Tissue Reconstructions with Dermal Substitutes Versus Alternative Approaches in Patients with Traumatic Complex Wounds.

The use of dermal substitutes is considered an effective treatment in several pathologies involving skin damage, mainly extensive burns and trauma. Treatment alternatives entail performing flaps or autografts. The purpose of this cross-sectional study is to assess the clinical effects and cost-effectiveness of dermal substitutes in surgical procedure in complex wound healings of adult trauma patients. The study includes 52 patients who received dermal substitutes (n = 25) between 2007 and 2012 and patients treated between 2006 and 2011 who received standard treatment (n = 27). All patients presented with posttraumatic soft tissue defects with bone and/or tendon exposure. Differences in costs, mean differences in Euros and Euros per square centimeter, and clinical data were collected as outcome measures. Pearson's correlations were used to assess the relationship between total costs with sociodemographic data and clinical services to different healthcare providers (clinical data and costs were recorded for both groups). No relevant differences on acceptance rates were noticed amongst groups. Surgery costs were shown to be significantly reduced in the dermal substitutes group (P < 0.01) even though total costs (surgery + hospitalization) did not exhibit a significant difference. Surgical time was significantly reduced in the dermal substitutes group (1.81 min/cm(2) lesions) as compared with the standard group (6.08 min/cm(2) lesions). The current study suggests that not only clinical but also possible economic and logistical advantages in choosing dermal substitutes may exist.