Negative Pressure Wound Therapy Reduces the Effectiveness of Traditional Local Antibiotic Depot in a Large Complex Musculoskeletal Wound Animal Model

Department of Regenerative Medicine, United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA.
Journal of orthopaedic trauma (Impact Factor: 1.8). 04/2012; 26(9):512-8. DOI: 10.1097/BOT.0b013e318251291b
Source: PubMed


Negative pressure wound therapy (NPWT) has been used to help manage open wounds. Surgeons also often use local antibiotic depot as adjunctive therapy in an effort to reduce infection rates. These 2 techniques have been reported to be used in conjunction, but there are little data to support this practice. We sought to compare the contamination levels of wounds treated with the commonly used antibiotic bead pouch technique to wounds that received both antibiotic beads and NWPT.
The effectiveness of a bead pouch was compared with antibiotic beads with NPWT. The anterior compartment and proximal tibia of goats were injured and inoculated with Staphylococcus aureus. Six hours later, the wounds were debrided and the animals were assigned to a group; the bacteria level was quantified immediately before and after initial debridement and 2 days after treatment.
The wounds in the antibiotic bead pouch group had 6-fold less bacteria than the augmented NPWT group, 11 ± 2% versus 67 ± 11% of baseline values, respectively (P = 0.01). As expected, high levels of the antibiotic were consistently recovered from the augmented NPWT effluent samples at all time points.
NPWT reduces the effectiveness of local antibiotic depot. These results can provide surgeons with the information to personalize the adjunctive therapies to individual patients, with the degree of difficulty in managing the wound and concern for infection being the 2 variables dictating treatment.

Download full-text


Available from: Daniel Stinner, Mar 01, 2015
  • Source
    • "NPWT therapy may reduce the effectiveness of antibiotic loaded polymethylmethacrylate (PMMA) bone cement beads. Stinner et al. [30] used a live animal wound model to demonstrate a reduction in effectiveness of vancomycin-impregnated cement beads when used in conjunction with NPWT. The wounds not subjected to NPWT showed a 6-fold reduction in bacteria after 2 days of treatment. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The use of Negative Pressure Wound Therapy (NPWT) for complex and large wounds has increased in popularity over the past decade. Modern NPWT systems consisting of an open pore foam sponge, adhesive dressing and a vacuum pump producing negative pressure have been used as an adjunct to surgical debridement to treat tissue defects around open fractures and chronic, contaminated wounds. Other uses include supporting skin grafts and protecting wounds at risk of breaking down. This review outlines the current and emerging indications for negative pressure wound therapy in Orthopaedic trauma and the existing preclinical and clinical evidence base for its use.
    The Open Orthopaedics Journal 06/2014; 8(1):142-7. DOI:10.2174/1874325001408010142
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Negative-pressure wound therapy (NPWT) has become an important adjunct to the management of traumatic wounds and surgical incisions related to musculoskeletal trauma. On the battlefield, this adjunct therapy allows early wound management and safe aeromedical evacuation. NPWT mechanisms of action include stabilization of the wound environment, reduction of wound edema, improvement of tissue perfusion, and stimulation of cells at the wound surface. NPWT stimulates granulation tissue and angiogenesis and may improve the likelihood of primary closure and reduce the need for free tissue transfer. In addition, NPWT reduces the bacterial bioburden of wounds contaminated with gram-negative bacilli. However, an increased risk of colonization of gram-positive cocci (eg, Staphylococcus aureus) exists. Although NPWT facilitates wound management, further research is required to determine conclusively whether this modality is superior to other management options. Ongoing research will continue to define the indications for and benefits of NPWT as well as establish the role of combination therapy, in which NPWT is used with instillation of antibiotic solutions, placement of antibiotic-laden cement beads, or silver-impregnated sponges.
    The Journal of the American Academy of Orthopaedic Surgeons 09/2012; 20(9):564-74. DOI:10.5435/JAAOS-20-09-564 · 2.53 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Time and manpower constraints associated with acute combat casualty care can make antibiotic bead production at the point of care prohibitively difficult, if not impossible. The purpose of this study is to evaluate our technique for the sterile prefabrication of antibiotic-impregnated polymethylmethacrylate (PMMA) beads in the combat hospital environment by assessing their sterility at the time of use. This investigation is a prospective study of a consecutive series of specimens. Imipenem-impregnated antibiotic beads were sterilely prepared, threaded on a suture strand, and packaged. Over a 6-week period, 50 consecutive packages were evaluated for sterility with aerobic and anaerobic culture swabs performed at the time of opening. Culture results, as well as number of shelf days for each specimen, were then reviewed. Of the 50 packages of antibiotic-impregnated PMMA beads, the average number of days on the shelf before use was 9.3 (range: 2-17). None of the packages showed growth of organisms from the cultures, indicating that antibiotic-impregnated PMMA beads can be sterilely produced and maintained in their sterile state for future use in the combat hospital environment. This practice should be considered a safe adjunct in the management of contaminated, open traumatic injuries in this setting.
    Military medicine 03/2013; 178(3):330-333. DOI:10.7205/MILMED-D-12-00291 · 0.77 Impact Factor
Show more