Vacuum-assisted Closure Therapy Research Articles

Role of Vacuum Assisted Closure Therapy Compared to Standard Moist Wound Dressing in the Treatment of Diabetic Foot Ulcers.

Role of Vacuum Assisted Closure Therapy Compared to Standard Moist Wound Dressing in the Treatment of Diabetic Foot Ulcers.

Functional Outcomes in Orthopaedic Open Wounds Treated With Vacuum-Assisted Closure Therapy: A Prospective Case Series.

Open fractures with extensive soft-tissue damage, significant periosteal stripping, and exposed bone ends pose a significant challenge in orthopaedics. So, we conducted a prospective study that investigated the efficacy of vacuum-assisted closure (VAC) therapy in improving functional outcomes for orthopaedic open wounds. A prospective case series was conducted for a period of 18 months at the department of orthopaedics. Seventeen patients with open wounds were included in the study after fulfilling specific criteria. The study involved 17 patients with open wounds, where VAC therapy was applied within 24 hours of admission for 14 patients, and for three patients with superficial infection, thorough wound debridement preceded VAC dressing. Follow-up with patients continued until definitive skin cover procedures were performed. The majority of cases were attributed to open compound fractures caused by road traffic accidents (82.35%), followed by train traffic accidents (11.76%) and accidental falls (5.88%). The leg (47%) was the most common location of injury, followed by the forearm (23.52%). The average treatment duration was 10.5 days, with an average of 3.3 dressing changes, indicating the efficacy and feasibility of VAC therapy in clinical practice. The average wound size reduction at completion was 15mm, and 15 out of 17 patients achieved successful wound healing. The average time required for forming a uniform granulation bed was 10.5 days, highlighting the efficiency of VAC therapy in promoting tissue regeneration. Our study findings revealed that there is a significant reduction in the rate of wound infection with the application of VAC therapy, along with a shorter duration for the formation of healthy granulation tissue, rendering the wound suitable for definitive skin cover procedures such as split skin graft and flap cover at an accelerated rate. Additionally, technical challenges associated with applying VAC dressing in the presence of an external fixator were successfully managed through realignment strategies, further underscoring the adaptability and efficacy of VAC therapy in addressing complex wound scenarios.

Evaluation of Clinical Outcomes of Negative-Pressure Wound Therapy in Gustilo-Anderson Type IIIA/IIIB Open Fractures of Extremities.

Background Open fractures are common and serious injuries that primarily affect young males. Fracture management has improved in the last decade. However, infections with their complications are still a concern, especially in open fractures for primary closure of the injured area. A newer technique called vacuum-assisted therapy has become a therapy of choice for many orthopedic surgeons. This study aimed to determine whether vacuum-assisted closure reduces the duration of wound healing and the frequency of infections after fixation of Gustilo-Anderson Type IIIA/IIIB fractures of the extremities. Methodology An observational analytical study was conducted among 34 patients with Gustilo-Anderson Type IIIA/IIIB fractures of the limbs who presented to the Department of Orthopaedics, R. L. Jalappa Hospital, Kolar, from December 2019 to July 2021. Negative-pressure wound therapy was employed for wound closure after fixation of fractures. Patients were followed up for one month. Results The mean age of the patients was 37.06 ± 10.340 years. The prevalence of infection before vacuum-assisted closure dressing was 80.6%, and the prevalence of infection after vacuum-assisted closure dressing was 19.4%. The difference in proportion before versus after the intervention was statistically significant (p < 0.001) according to the McNemar Test.Hence, vacuum-assisted closure dressing decreased the rate of infection. The mean dimension of the wound before vacuum-assisted closure therapy was 66.05 cm2 and the mean dimension of the wound after vacuum-assisted closure therapy was 27.97 cm2. The difference in the mean before and after the intervention was statistically significant according to the paired t-test (p < 0.001). Hence, vacuum-assisted closure dressing helped decrease the wound size which was proven statistically. Conclusions Vacuum-assisted closure is a viable and beneficial treatment option for complicated fractures with large soft-tissue abnormalities.

Kyphectomy and sliding growing rod technique in patients with congenital lumbar kyphosis deformity with myelomeningocele

ObjectiveNeural tube defects are the most common congenital disorders after cardiac anomalies. Lumbar kyphosis deformity is observed in 8–15% of these patients. This deformity severely limits the daily lives of these patients. In our study, we aimed to correct the kyphosis angle of the patients with lumbar kyphosis associated with myelomeningocele (MMC) and allow them to continue their growth without limiting their lung capacity by applying kyphectomy and sliding growing rod technique.Patients and methodsIn this study, we retrospectively evaluated 24 patients with congenital lumbar kyphosis deformity associated with MMC, aged between 4 and 9 years, and who applied to Umraniye Training and Research Hospital between the dates of 2018 and 2021. We evaluated preoperative and postoperative kyphosis angles, correction rates, bleeding during operations, operation time, level of instrumentation, number of the resected vertebrae, initial levels of the posterior defects, duration of hospital stays, annual lengthening, and weight of the patients.ResultsMean age was 5.04 (between 4 and 9). Mean preoperative and early postoperative kyphosis angles were 129.8° (87–175°) and 0.79° (− 20–24°), respectively. The kyphotic deformity correction rate was 99.1%. A difference was found regarding kyphosis measurements between preoperative and early period values (p < 0.05). The annual height lengthening of patients was calculated as 0.74 cm/year and 0.77 cm/year between T1–T12 and T1–S1, respectively. Mean preoperative level of hemoglobin (Hgb) was 11.95, postoperative Hgb value was 10.02, and the decrease was significant (p < 0.05). In terms of complications, 50% (12) had broken/loosen screws, 50% (12) had undergone debridement surgery, 37.5% (9) had vacuum-assisted closure therapy, and 33.3% (8) had to get all of their implants removed.ConclusionWe believe that our sliding growing rod technique is a new and updated surgical method that can be applied in these patient groups, facilitating the life, rehabilitation process, and daily care of MMC patients with lumbar kyphosis. This technique seems to be a safe and reliable method which preserves lung capacity and allows lengthening.

Vacuum-assisted closure for chest wall reconstruction infection caused by Streptococcus mitis after surgery of lung cancer: a case report

BackgroundAmong a cohort of patients who underwent chest wall resection and reconstruction by rigid prosthesis, 6% required removal of the prosthesis, and in 80% of these cases the indication for prosthesis removal was infection. Although artificial prosthesis removal is the primary approach in such cases of infection, the usefulness of vacuum-assisted closure (VAC) has also been reported.Case presentationA 64-year-old man with diabetes mellitus underwent right middle and lower lobectomy with chest wall (3rd to 5th rib) resection and lymph node dissection because of lung squamous cell carcinoma. The chest wall defect was reconstructed by an expanded polytetrafluoroethylene (PTFE) sheet. Three months after surgery, the patient developed an abscess in the chest wall around the PTFE sheet. We performed debridement and switched to VAC therapy 2 weeks after starting continuous drainage of the abscess in the chest wall. The space around the PTFE sheet gradually decreased, and formation of wound granulation progressed. We performed wound closure 6 weeks after starting VAC therapy, and the patient was discharged 67 days after hospitalization.ConclusionsWe experienced a case of chest wall reconstruction infection after surgery for non-small cell lung cancer that was successfully treated by VAC therapy without removal of the prosthesis. Although removal of an infectious artificial prosthesis can be avoided by application of VAC therapy, perioperative management to prevent surgical site infection is considered essential.

Usefulness of Endoluminal Vacuum-Assisted Closure Therapy for Pharyngocutaneous Fistula

Pharyngocutaneous fistula (PCF) is a communication created between the pharynx and skin of the neck associated with flap reconstruction or primary closure of a pharyngeal defect. In patients who underwent laryngectomy and pharyngectomy, salivary accumulation in the deep neck space through the pharyngeal dehiscence can cause life-threatening complications, among which is carotid artery blow-out. Broad-spectrum antibiotics, compressive dressing, and artificial nutrition are usually applied first. Many closing methods have been studied, both surgically (direct repair or using flaps) and non-surgically (negative pressure therapy, hyperbaric oxygen therapy, or botulinum toxin injection). The use of a vacuum-assisted closure system placed endoluminally or externally has been recently reported to treat any leaks in the upper gastrointestinal tract. Here, we report a successfully-treated PCF using the endoluminal vacuum-assisted closure system.

Comparison of Vacuum Assisted Closure Therapy and Nano-Silver Coated Dressing on Wound Healing in Patients with Diabetic Foot Wound: A Randomized Prospective Trial

Background Diabetic foot ulcers constitute one of the most important complications of diabetes mellitus. If not treated promptly, progression of infection and sepsis may necessitate a limb amputation. Aim To assess wound healing and to assess the time for wound healing of diabetic foot ulcers using vacuum-assisted closure (VAC) in comparison with nano-silver coated dressing. Patients and methods This was a simple randomized cohort prospective trial included two groups of postoperative diabetic foot patients, in which we had a comparison between VAC and nano-silver dressing in order to investigate which procedures had the least time of follow up weeks for full granulation of wound. Results VAC significantly reduces the time to complete wound healing by enhancement the formation of granulation tissue. Conclusion The time to complete wound healing was significantly better in the VAC therapy group as compared with nano-silver dressing.

IMPROVING SURGICAL STRATEGIES FOR TREATING EXTENSIVE SOFT TISSUE WOUNDS RESULTING FROM MINE AND EXPLOSIVE TRAUMA

Introduction.Since February 24, 2022, a primary focus of surgical care in Ukraine has been to provide assistance to citizens affected by Russian aggression. A significant proportion of wounds and injuries sustained in this context involves mine-explosive wounds, manifesting as soft tissue damage in the form of lacerations, shrapnel injuries, and wounds of varying degrees of contamination and size.&#x0D; The widespread adoption of Vacuum-Assisted Closure (VAC) therapy for wounds characterized by extensive muscle and skin defects involves the localized application of negative pressure to damaged tissues. Typically, this precedes planned autodermoplasty, which, despite being a scheduled intervention, follows urgent surgical corrections. These interventions offer a distinct opportunity for individuals with substantial soft tissue injuries— and, as evidenced by experience, not limited to them— to restore their pre-injury quality of life.&#x0D; The aim of this study is to enhance the quality of life for individuals affected by mine-explosive injuries and extensive soft tissue wounds.&#x0D; Materials and methods. The outcomes of surgical treatment of 57 civilian victims afflicted by landmine-explosive wounds and extensive soft tissue injuries were examined. These individuals underwent treatment at the Surgical Department of the Regional Clinical Hospital" during the period 2022 – 2023. Among the cohort, 34 were women, constituting 59%, while 23 were men, representing 41%, the ages of the patients ranged from 34 to 74 years.&#x0D; Results and discussion. All 57 patients initially underwent surgical treatment of wounds, involving the removal of foreign bodies if present, necrectomy, and subsequent application of the second-stage Vacuum-Assisted Closure (VAC) therapy. The VAC therapy was used to cleanse the wounds and reduce their surface area. Continuous VAC therapy was administered at a negative pressure ranging from 50 mmHg (on the anterior abdominal wall and the back surface of the chest) to 110 mmHg (on tissues of the lower extremities). The replacement of the VAC dressing occurred every 3-5 days, contingent upon the quantity and quality of the exudate, with typically 2-3 changes required. The third stage involved the application of free autodermoplasty utilizing a perforated skin flap. Mechanical wound treatment was performed iteratively until the level of "bloody dew" was reached.&#x0D; We suggest that all these stages are essential for achieving favorable treatment outcomes, irrespective of any severe accompanying pathology that may arise. Indeed, comorbidity stands out as a defining factor that distinguishes the civilian population qualitatively from the military category.&#x0D; Conclusions. The application of Vacuum-Assisted Closure (VAC) therapy followed by autodermoplasty in the management of extensive soft tissue injuries caused by mine-explosive incidents significantly enhances the efficacy of surgical treatment and reduces the period of patient incapacitation, presenting clear economic benefits. Autodermoplasty, in particular, holds a commendable position within the realm of reconstructive surgery for mine and explosive wounds. Within this context, autodermoplasty emerges as a surgical intervention that not only yields positive aesthetic outcomes but also facilitates an accelerated adaptation of the affected body part. This, in turn, contributes to an improved quality of life for victims of mine-explosive trauma grappling with substantial soft tissue damage.

Evaluation of Negative Pressure Wound Therapy in the Management of Fournier's Gangrene.

Introduction Necrotizing soft tissue infections (NSTIs), including Fournier's gangrene (FG), are severe polymicrobial bacterial infections characterized by rapidly spreading inflammation and tissue necrosis. This study aims to compare the clinical outcomes of vacuum-assisted closure (VAC) dressing and conventional dressing in patients with FG. Materials and methods A prospective study was conducted from December 2020 to May 2022, including patients with clinical features suggestive of FG. Patients were divided into two groups: conventional dressing and VAC dressing. Relevant clinical data, including age, duration of hospital stay, wound status, Fournier's gangrene severity index (FGSI) scores, sepsis markers (C-reactive protein (CRP), neutrophil-to-lymphocyte ratio, and procalcitonin), and pain assessment, were recorded and compared between the two groups. Results A total of 84 patients were included in the study, with 42 patients in each group. The mean age was 57.48 ± 15.74 years in the conventional dressing group and 50.83 ± 13.95 years in the VAC dressing group. VAC dressing was associated with a significantly shorter duration of hospital stay (8.14 ± 3.13 days) compared to conventional dressing (11.36 ± 4.75 days). The average time taken for wound closure was significantly reduced in the VAC dressing group (63 ± 14.81 days) compared to the conventional dressing group (112.56 ± 13.82 days). FGSI scores showed significant improvement after debridement in both groups, with lower scores in the VAC dressing group at discharge. Sepsis markers such as CRP and serum procalcitonin exhibited a significant decrease after VAC application. Discussion The study demonstrates that VAC therapy is associated with better clinical outcomes in FG, including reduced duration of hospital stay, faster wound closure, improved FGSI scores, decreased sepsis markers, and reduced pain. These findings align with previous studies highlighting the advantages of VAC therapy over conventional dressing methods. Conclusion VAC therapy provides significant benefits in the management of FG, leading to improved clinical outcomes and patient quality of life. It offers advantages such as shorter hospital stays, faster wound closure, and reduced sepsis markers. The application of VAC dressing should be considered a valuable treatment modality for FG.

Comparative study between vacuum-assisted closure therapy and tetra-silver nitrate in the management of diabetic foot ulcer

Background Diabetes-related foot ulcers are becoming more common. The percentage range is 15 to 25%. Several procedures and dressing agents have been investigated. In the vacuum-assisted closure technique, sub-atmospheric pressure is employed to accelerate the healing process. Aim and objectives In this study, the healing rates of diabetic foot ulcers (DFUs) treated with tetra-silver nitrate dressing were compared with those treated with negative pressure wound care. Patients and methods More than 30 patients were randomly allocated to one of two study groups by the Vascular Surgery department at Aswan University Medical School. Group A received a vacuum-assisted closure (VAC) dressing for a total of 30 patients, while group B received tetra-silver nitrate. Result After 6 weeks, there was a statistically significant difference in wound-healing rates between the two groups. Conclusion Patients who got VAC developed granulation tissue faster than those who received tetra-silver nitrate. VAC treatment is safe and effective in diabetic foot ulcers. Granulation tissue formation accelerates healing and reduces the risk of problems such as infection or amputation.

Commentary on: The use of vacuum-assisted closure (VAC) therapy for management of deep sternal wound complications: A systematic review and meta-analysis

Commentary on: The use of vacuum-assisted closure (VAC) therapy for management of deep sternal wound complications: A systematic review and meta-analysis

Successful Reconstruction of Complex Sacrococcygeal Defects Using Chimeric Perforator Propeller Flap.

Complex soft tissue defects, which result from the surgical resection of sacral tumors, manifest as a combination of skin defects, dead space, infection, and prosthesis exposure. Because the traditional musculocutaneous flap lacks flexibility because of the close connection between the skin flap and the muscle component, the musculocutaneous flap is not suitable for reconstructing complex soft tissue defects where the dead space and skin defects are located at different sites. Furthermore, the perforator flap is also not appropriate for reconstructing complex defects because it lacks the muscular component. We considered the possibility of using the chimeric perforator propeller flap for reconstructing complex sacrococcygeal defects. This study included 7 patients who underwent, between July 2007 and July 2021, the reconstruction of complex soft tissue defects of the sacrococcygeal region using a chimeric perforator propeller flap. Among the included cases, the etiologies were chordoma (n = 3), sacral tumor (n = 3), and squamous cell carcinoma (n = 1). In all the cases, vacuum-assisted closure therapy was used to treat wound infections before surgery. The average sizes of the skin and muscle flaps were 195.8 cm 2 (range, 100-350 cm 2 ) and 83.6 cm 2 (range, 60-140 cm 2 ), respectively. The superior gluteal artery was the source artery for the chimeric perforator propeller flap. The donor sites were primarily closed in all cases. One patient had delayed wound healing, and the secondary wound healed using conservative dressing changes. The other 6 flaps had no complications. The average follow-up time was 5.3 months (range, 1-9 months). Muscle weakness and compromised ambulation in the affected lower extremities were not observed in any of the patients. Furthermore, all 7 patients had no tumor recurrence, prosthesis exposure, and infection events in the sacrococcygeal region. The chimeric perforator propeller flap may be an option for reconstructing complex soft tissue defects in the sacrococcygeal region.

Use of vacuum-assisted closure in the treatment of complex intrapleural infections

Background: Debilitated patients with chronic empyema, who are not fit enough to undergo thoracotomy and decortication due to lung entrapment, may be offered a lower-risk alternative – an open-window thoracostomy. Vacuum-assisted closure (VAC) may accelerate empyema drainage and wound closure.&#x0D; Methods: In this study, we compared two cohorts of patients receiving open-window thoracostomy (OWT) with or without VAC dressing. We included patients with chronic or postresectional empyema with multiple comorbidities or in poor general condition or on immunosuppression.&#x0D; Results: Delayed wound closure by thoracoplasty was performed in 8 (28%) patients in the OWT group and 8 (53%) patients in the OWT-VAC group (OR 2.54; 95% CI: 0.704-9.168). Time until DWC was significantly shorter (p&lt;0.001) in the OWT-VAC group (48.5 ± 27.5 days) compared to the OWT group (316.5 ± 102.5 days). Regarding complications, we found no significant differences between the two groups, except for air leak, which was found in 0 (0%) patients in the OWT group and 6 (40%) patients in the OWT-VAC group (OR 1.67; 95% CI: 1.10-2.52; p&lt;0.001). The percentage of patients who required re-do surgery did not differ significantly between the groups - 1 (3%) patient in the OWT group vs. 2 (13%) patients in the OWT-VAC group (OR 7.0; 95% CI: 0.66 – 74.29; p=0.07).&#x0D; Conclusion: Our experience shows that using VAC therapy in OWT can significantly shorten the overall treatment time. It can be safely used at home and in an outpatient setting.

Switching from Galenic to Advanced Dressings or Vacuum Assisted Closure Therapy Can Improve Quality of Life of Patients with Chronic Non-Responsive Pressure Skin Ulcers: Preliminary Data with Italian Translation of WOUND-Q.

Objective: A few studies have focused on the quality of life (QoL) of patients with chronic non-responsive pressure skin ulcers. The aim of this study was to assess how correct treatment (advanced wound care [AWC] dressings alone or vacuum assisted closure [VAC] therapy alone) changes the QoL of these patients. Approach: One hundred six patients with chronic non-responsive pressure skin ulcers, who had previously used galenic dressings, applied without proper therapeutic indication, were included in this study. We administered the WOUND-Q, at time 0 and after 1 month of appropriate therapy, to assess patient-reported outcome measures. Group 1 consisted of 30 patients treated with advanced dressings, Group 2: 22 patients treated with VAC therapy, and Group 3: 30 patients continuing conventional galenic dressings (Control group). Statistical analysis allowed us to analyze QoL changes over time and to compare WOUND-Q Group 1 and 2 deltas with those of Group 3. The study followed the STROBE statement. Results and Innovation: In all the scales evaluated (Assessment, Drainage, Smell, Life impact, Psychological, Social, Sleep and Dressing), there were significant improvements in mean values for Groups 1 and 2. Kruskal-Wallis tests with Dunn's multiple-comparisons tests and Brown-Forsythe and Welch Analysis of Variance tests demonstrated significant differences between deltas of Group 1 and Group 2 compared with those of Group 3 for most scales analyzed. Conclusions: Administration of the WOUND-Q demonstrated that the application of advanced dressings alone or VAC therapy alone positively affects the QoL of patients with chronic nonresponsive pressure wounds, in comparison with galenic dressings alone. The WOUND-Q has been shown to be a valid tool in studying changes in QoL of these patients.

Indigenously modified endoluminal vacuum-assisted closure therapy for post-operative gastrointestinal leaks: Successful case series

Treatment of gastrointestinal perforations and postoperative anastomotic leaks remains a challenge. Endoluminal Vacuum-assisted closure (E-Vac) therapy has positively contributed, in recent years

The efficacy of negative pressure wound therapy for surgical site infections and delayed wound healing in intensive care unit department of ha noi heart hospital from 2020 to 2021

Objective: Describe the clinical characteristics and the results of negative pressure wound therapy for surgical site infections and delayed wound healing.&#x0D; Methods: A descriptive, cross-sectional study was conducted between May, 2020 and May, 2021 to evaluate the effectiveness of negative pressure wound therapy among patients with delayed surgical wound healing and wound infection in intensive care unit department of Ha Noi Heart hospital.[1]&#x0D; Results: From May 2020 to May 2021, we studied a total of 15 patients with delayed wound healing and surgical wound infection using negative pressure wound therapy. Among them, there are 9 women (60%), 6 men (40%), The majority of patients was over the age of 60 (86.7%). After you have used VAC, 13/15 cases the wound was improved (86.7% proportion). VAC therapy over the wound was administered for an average of  9,4 days.&#x0D; Conclusion: Vacuum-Assisted Wound Closure Therapy is a reliable and safe option for patients with postoperative surgical site infections and delayed wound closure to help reduce hospital length of stay, improves financial and clinical outcomes.

Is vacuum-assisted closure therapy the main culprit in right ventricular rupture after deep sternal wound infection?

Right ventricular rupture after deep sternal wound infection (DSWI) is a rare but fatal complication, and can occur with or without vacuum assisted closure (VAC) therapy. There is currently no strong evidence to suggest whether or not VAC therapy is a contributing factor to this complication. In total, 30 articles were retrieved and assessed through a systematic review strategy from 1953 to 2022. The keywords: 'vacuum assisted closure'; 'VAC'; 'negative pressure wound therapy'; 'deep sternal wound infection'; 'DSWI'; 'right ventricular rupture'; and 'cardiac rupture' were used in the search. Overall, 15 of the included articles satisfied the predefined eligibility criteria. Fatal right ventricular ruptures were reported in 18 (36%) out of 50 cases. In this article, the risk factors, mechanisms and management of right ventricular rupture are discussed. A novel view of the mechanism of VAC-associated right ventricular rupture is highlighted, with a focus on both pre- and intraoperative management.

Vacuum-assisted closure therapy for an empyema with bronchopleural fistula with artificial dermis covering the bronchial stump

BackgroundVacuum-assisted closure (VAC) therapy has recently been reported to be useful for treating empyema complicated by bronchopleural fistula (BPF). Since the pleural cavity must be closed to apply this treatment, various fistula closure methods for the fistula have been used in previous reports. We report a case in which VAC therapy could be applied more safely by simply covering the fistula with an artificial dermis.Case presentationA 72-year-old man who underwent thoracoscopic lower lobectomy of the right lung for squamous cell carcinoma pT1cN0 developed BPF on the postoperative day 22. First, infection control was achieved by open-window thoracostomy and antibiotic therapy. Subsequently, VAC therapy was applied by covering the fistula with an artificial dermis, and closure of the bronchial stump was completely achieved. Subsequently, the thoracostomy was closed surgically.ConclusionCovering the fistula with an artificial dermis allowed for the introduction of VAC therapy when treating empyema complicated by BPF.

A Very Rare Pathogen of Osteomyelitis: Alcaligenes faecalis.

To the Editors: Alcaligenes faecalis is a Gram-negative, rod-shaped, oxidase-positive, catalase-positive, obligate aerobic, motile and nonfermenting bacteria.1 It is commonly found in the environment (soil or water) and in the human gut.2A. faecalis has been associated with various infections such as bacteremia, meningitis, endophthalmitis, endocarditis, skin and soft tissue infections, urinary tract infections, peritonitis, otitis media and pneumonia.3 Here, we present 2 patients with osteomyelitis due to A. faecalis, a rarely reported clinical condition in the literature. Patient 1: An 18-year-old female with a medical history of operated for meningomyelocele and pes cavus was admitted with worsening pain in her right lower extremity. On admission, she was afebrile with normal vital signs there was a chronic ulcerated wound with seropurulent discharge on the right foot. On the laboratory evaluation, there was no leukocytosis, C-reactive protein, and procalcitonin were negative, erythrocyte sedimentation rate was 35 mm/h. Clindamycin 30 mg/kg/d and cefotaxime 200 mg/kg/d intravenously (IV) were administered empirically. The contrast-enhanced magnetic resonance imaging showed cellulitis in soft tissue and osteomyelitis in the bone at the level of the 5th finger metatarsal base and proximal shaft (Fig. 1). Wound debridement was performed by orthopedics. She developed emesis and rash on day 4 and the antibiotic was changed to IV ciprofloxacin (30 mg/kg/d). Intraoperative wound culture grew A. faecalis which was sensitive to ampicillin, cefotaxime and gentamicin. Due to clinical improvement, treatment with ciprofloxacin continued and she was discharged after 15 days of IV therapy. The total treatment is planned to be completed in 8 weeks.FIGURE 1.: MRI (T2 weighted) showing osteomyelitis of the right foot. MRI indicates magnetic resonance imaging.Patient 2: A 15-year-old girl presented with a chronic ulcerated wound on her right foot. She had been operated twice for meningomyelocele and had pes planovalgus. She was afebrile and there was a chronic wound without any discharge on her right foot on admission. Laboratory evaluation revealed negative acute phase reactants and erythrocyte sedimentation rate was 24 mm/h. The empirical treatment was administered as IV cefotaxime and clindamycin. The contrast-enhanced magnetic resonance imaging showed findings suggestive of active osteomyelitis on the right calcaneus (Fig. 1). Orthopedics performed wound debridement and inserted vacuum-assisted closure therapy system. A. faecalis growth was detected in the tissue culture which was sensitive to ceftazidime and meropenem but resistant to amikacin. Her treatment was changed to IV ceftazidime (150 mg/kg/d). After vacuum-assisted closure treatment, it was planned to perform tissue repair by plastic surgery and to continue antibiotherapy IV due to the resistance pattern of the microorganism. Opportunistic infections and antimicrobial resistance associated with A. faecalis have been reported but osteomyelitis due to A. faecalis was documented in a few patients with diabetic foot ulcers in the literature.4 It is usually sensitive to beta-lactam antibiotics and trimethoprim/sulfamethoxazole and resistant to aminoglycosides and tetracyclines.5 Most of the previously documented cases have been successfully treated with amoxicillin/clavulanic acid but antibiotic resistance is an emerging problem. In summary, we present 2 patients with osteomyelitis due to A. faecalis, a rare cause of osteomyelitis. In addition to surgery, medical treatment should be arranged based on the antibiotic susceptibility results for successful and appropriate treatment.

Handmade spacers for two-stage exchange at the hip.

Two-stage exchange with implantation of atemporary spacer is the gold standard treatment for chronic periprosthetic joint infection of the hip. This article describes asimple and safe technique for handmade spacers at the hip. Periprosthetic joint infection of the hip. Septic arthritis of the native joint. Known allergy against components of polymethylmethacrylate bone cements. Inadequate compliance for two-stage exchange. Patient unfit to undergo two-stage exchange. Bony defect situation at the acetabulum impeding stable reduction of the spacer. Bone loss at the femur jeopardizing stable fixation of the stem. Soft tissue damage with need for plastic temporary vacuum-assisted wound closure (VAC) therapy. Tailoring bone cement with antibiotics. Preparation of ametal endoskeleton. Molding of spacer stem and head by hand. Customizing spacer off-sets to bony anatomy and soft tissue tension. Implantation assuring rotational stability at the femur with abone cement collar. Confirmation of correct position by intraoperative radiography. Restricted weight-bearing. Range of motion as possible. Reimplantation after successful treatment of infection.