[Posttraumatic Osteomyelitis: Improvement in Outcome by Negative Pressure Wound Therapy with Instillation Technique]. / Posttraumatische Osteomyelitis: bessere Behandlungsergebnisse durch innovative Vakuumversiege­lungstechnik mit Instillationstherapie.

Posttraumatic Osteomyelitis: Improvement in Outcome by Negative Pressure Wound Therapy with Instillation Technique Abstract. Surgical treatment of post-traumatic (fistula) osteomyelitis can be difficult and is associated with an increased risk of later recurrence. Very often osteomyelitis is accompanied by a soft tissue (defective) wound. After surgical debridement, the use of the vacuum sealing technique can stimulate wound healing and improve local blood circulation. In particular, the introduction of the innovative instillation technique for wound sponges can increase the effectiveness of the treatment of the infection. By regularly rinsing the sponges with an antiseptic polyhexanide solution, the duration of treatment, the number of operations, the in-patient stay and the recurrence rate in this patient group can be statistically significantly reduced.

Negative pressure wound treatment with polyvinyl alcohol foam and polyhexanide antiseptic solution instillation in posttraumatic osteomyelitis.

In a retrospective, case-control cohort study an assessment was made of the clinical outcome of patients with osteomyelitis treated with a new modality of negative pressure wound therapy, so called negative pressure instillation therapy. In this approach, after surgical debridement, a site of osteomyelitis is treated with negative pressure of at least 300 mmHg applied through polyvinyl alcohol dressing. The polyvinyl alcohol foam is irrigated through the tubes three times a day with a polyhexanide antiseptic solution. In 30 patients (14 males; mean age 52 [range, 26-81]) admitted between 1999 and 2003 with osteomyelitis of the pelvis or lower extremity, we assessed time to wound closure, number of surgical procedures and rate of recurrence of infection as well as need for rehospitalizations. For comparison, a control group of 94 patients (males, 58; mean age 47 [range, 9-85]), matched for site and severity of osteomyelitis, was identified in hospital records between 1982 and 2002. These patients underwent standard surgical debridement, implantation of gentamicin polymethylmethacrylate beads and long-term intravenous antibiotics. In the Instillation group the rate of recurrence of infection was 3/30 (10%), whereas 55/93 (58.5%) of the controls had a recurrence (p<0.0001). Moreover, in those treated with instillation the total duration of hospital stay was shorter and number of surgical procedures smaller as compared with the controls (all p<0.0001). We conclude that in posttraumatic osteomyelitis negative pressure instillation therapy reduces the need for repeated surgical interventions in comparison with the present standard approach.