Negative pressure sealing drainage with antibiotic bone cement for the treatment of skin and soft tissue defects in the older population with bone exposure

Abstract

Objective: To observe the clinical efficacy of vacuum sealing drainage (VSD) combined with antibiotic bone cement in the treatment of skin and soft tissue defects of the extremities with bone exposure in the older population.

Method: From January 2016 to December 2018, VSD combined with antibiotic bone cement was used to treat 12 older patients with skin and soft tissue defects of the extremities and bone exposure. The study cohort consisted of eight male patients and four female patients aged between 60-95 years, with a median of 75 years. The injury sites included four cases of hand, one case of calf, one case of ankle and six cases of back of foot. The area of skin and soft tissue defects ranged from 2.7×4.1cm to 4.8×4.9cm. There were four infected wounds and eight contaminated wounds. The time from injury to operation was 1.5-6 hours, with a median of 5 hours. In the first stage of the treatment, the wound was covered with a VSD dressing; in the second stage the VSD dressing was replaced with antibiotic bone cement after infection control; and in the third stage, the bone cement was removed and the wound was transplanted with medium-thickness skin grafts according to the wound condition. The skin graft survival and wound healing were assessed.

Results: After the first-stage debridement, three of the 12 patients had wound infections, including two cases of meticillin-resistant Staphylococcus aureus infection and one case of Pseudomonas aeruginosa infection. After the bone cement was removed in the third stage, five of the 12 patients underwent free medium-thickness skin grafting on the wound surface (the area of the autologous skin ranged from 2.9×4.3cm to 4.9×5.0cm), and seven patients continued to change dressing routinely. All patients were followed up for 4-15 months, with a median of 10 months. All skin grafts survived and the wounds healed. The healing time was 48-115 days, with a median of 72 days. At the last follow-up, the skin of the affected limb was slightly darker than the surrounding skin, and the appearance was smooth, without obvious scar tissue formation.

Conclusion: VSD combined with antibiotic bone cement in the treatment of skin and soft tissue defects of the extremities with bone exposure in the older population has a high survival rate of skin grafts and good wound healing. It is worthy of clinical application.

Keywords: antibiotic; bone cement; bone exposure; drainage; older; soft tissue trauma defect; vacuum sealing drainage; wound; wound care; wound dressing; wound healing.