Pyogenic infections in orthopaedic surgery: Combined antibiotic and closed wound treatment

Abstract

This is a preliminary report of experiences in the treatment of serious pyogenic infections of the motor-skeletal system in adults. Established surgical principles of treatment of infected wounds was observed. Open wound treatment was abandoned in favor of the closed technic with intermittent suction and combined antibiotic therapy. Antibiotic combinations were selected for simultaneous systemic and local administration in accordance with in vitro determinations of bactericidal activity. In addition to usual clinical criteria of success of treatment, periodic wound culture studies and assays of sera and wound exudates for antimicrobial activity were thought to provide dependable guidance. The results of treatment of acute postoperative infections in this small series was encouraging and have stimulated further study. Six acute infections following prosthetic arthroplasty were controlled and subsequently removal of metallic foreign bodies was not necessary because of recurrent infection. Analysis of two failures of treatment of infection after prosthetic arthroplasty suggested factors that in retrospect might have been significant causes. The most discouraging results were encountered in chronic or recurrent infections of bone where necrotic tissue, infected granulation tissue or extensive scarring of soft tissue were present. Inadequate operative removal of infected or necrotic tissue could not be compensated by adjunctive chemotherapy. Certain advantages and disadvantages of closed wound treatment and combined antibiotic therapy are discussed.