Abstract
Following extensive surgical debridement in the treatment of infection, a “dead space” can result following surgical closure that can fill with hematoma, an environment conducive to bacterial growth. The eradication of dead space is essential in order to prevent recurrent infection. This study describes a novel small animal model to investigate dead-space management in muscle tissue. Two absorbable test materials were implanted in each animal; beads of calcium sulfate alone, and beads loaded with vancomycin and tobramycin. In-life blood samples and radiographs were taken from each animal following implantation. Animals were sacrificed at 1, 7, 21, 42, and 63 days post-operatively (n = 4), and implant sites were analysed by micro-computed tomography, histology and immunohistochemistry. Complete resorption was confirmed radiographically at 3 weeks post-implantation. Histologically, the host tissue response to both materials was identical, and subsequent healing at the implant sites was observed with no dead space remaining. Vancomycin was not detected in blood serum. However, peak tobramycin levels were detected in all animals at 6 hours post-implantation with no detectable levels in any animals at 72 hours post implantation. Serological inflammatory cytokine expression for IL-6, TNF-α and IL-1β indicated no unusual inflammatory response to the implanted materials or surgical procedure. The model was found to be convenient and effective for the assessment of implant materials for management of dead space in muscle tissue. The two materials tested were effective in resolving the surgically created dead space, and did not elicit any unexpected adverse host response.
Highlights
When extensive debridement is required, patients are left with a dead space that, when closed, can fill with a hematoma or seroma, an environment conducive to the growth of bacteria
This study describes a novel animal model to investigate deadspace management in soft tissue, and the assessment of calcium sulfate in this model, alone and in combination with two antibiotics, vancomycin and tobramycin
Two test materials were implanted; beads of calcium sulfate alone (CS), and beads of calcium sulfate combined with vancomycin and tobramycin (CSVT)
Summary
When extensive debridement is required, patients are left with a dead space that, when closed, can fill with a hematoma or seroma, an environment conducive to the growth of bacteria. Local tissue flaps or free flaps may be used to fill dead space [3, 4]. This is not always possible, especially if significant debridement of soft tissue has taken place in the surgical site due to extensive removal of infected tissues. Antibiotic-impregnated polymethylmethacrylate (PMMA) beads impregnated with antibiotics, have been used for over three decades [5]. These beads are commonly used inside dead space [6, 7]. PMMA is frequently used in joint revision surgery in the form of a spacer [8, 9], and in the management of infected fractures [10] or in the form of beads on a wire or as a pouch [11]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
