Defensive antibacterial coating (DAC) hydrogel with gentamycin and vancomycin for the therapy of achilles tendon infection after surgical repair without massive soft-tissue defect. Results in 8 cases

Abstract

Abstract Introduction We report the results of revision surgery in postoperative infection after Achilles tendon (AT) suturing consisting of debridement of AT together with a local application of hyaluronic acid and polylactic acid hydrogel with an addition of gentamicin and vancomycin in suture canals and into an operative wound. Materials and Methods A retrospective study included eight patients operated due to a postoperative and unsuccessfully treated infection after AT suture. Before revision with defensive antibacterial coating (DAC) hydrogel, all patients underwent an unsuccessful antibiotic therapy, removal of sutures via the sinus tract. In none of the cases was there a skin defect due to a previous surgery and infection. In all cases, the AT healed at revision surgery, residual stiches were removed, and suture canals and adjacent soft tissue and anchor canals in the bone were debrided and filled with 5 ml DAC hydrogel with an addition of gentamicin and vancomycin. Results During the follow-up ranging from 6 to 43 months, all patients obtained a complete resolution of inflammation. No side effects related to DAC hydrogel were observed. Conclusion The use of 5 ml antibacterial DAC® hydrogel containing 160 mg gentamycin and 50 mg of vancomycin applied during revision surgery on the surface of AT and in suture canals in AT as an adjunct to surgical debridement for infection complicating repair of AT without a massive soft-tissue defect proved to be safe and effective. Level of Evidence: IV (case series).