Narrow Results

We report a novel method of debridement for penetrating trauma to the hand involving bone using a sterile hand drill. This provides a means for adequate clearance of debris which may otherwise be left in-situ due to poor access to the contaminants when conventional techniques of debridement are used.

Background: Purulent musculoskeletal infections often require surgical debridement and drainage. However, when the infection is extensive or involving multiple layers of tissues, maintaining drainage of the involved spaces can be difficult, even with the application of vacuum-assisted closure (VAC) therapy. Wide exposure and aggressive debridement is often required for such cases, which in turn may complicate wound coverage.

Methods: A retrospective review was performed for 16 patients with musculoskeletal infections treated surgically. The diagnosis for the patients consisted of necrotizing fasciitis, large soft tissue abscess, peri-hardware abscess, infected compartment syndrome, emphysematous osteomyelitis, and gas gangrene of diabetic foot. We minimized the incision and resection for debridement and drainage, and instead we placed multiple foam pieces between the tissues involved with VAC, to maintain drainage of the hidden spaces with negative pressure.

Results: Infection was successfully controlled in all cases. The mean duration of VAC treatment was 16.1 days (range, 5–36) and the mean number of VAC changes was 5.1 (range, 1–13). Primary wound closure was achieved in 11 cases, while skin grafts were used to cover the remaining five cases, which consisted of necrotizing fasciitis, infected compartment syndrome, and diabetic foot gas gangrene. No complications specifically associated with VAC therapy were observed.

Conclusions: VAC using multiple foam pieces for hidden space drainage appears to be effective for infection control. It is helpful for minimizing exposure and resection for drainage and debridement, although subsequent reduction of the necessity or the level of wound coverage should further be investigated.

Necrotic diabetic foot ulcers present with necrotic and non-viable tissue that impairs the normal wound healing process. Frequent debridement is required to clear the wound of non-viable tissue. Low-frequency ultrasound is a form of mechanical debridement by way of cavitation and acoustic streaming effects. Fibrin deposits and bacteria are flushed out and cellular activities important for wound healing are stimulated. Ultrasonic debridement provides a mechanical solution for the management of patients that are at risk of amputation. It has been found to be effective in the debridement of dirty chronic diabetic wounds and is especially useful when the patients are too ill for surgical debridement.