Here - EWMA 2013

ORAL PRESENTATIONS
168
Free Paper Session: Negative Pressure Wound Therapy
NPWT* AND ANTIBIOTIC TREATMENT: A COMPLEX THERAPEUTIC STRATEGY
TO TREAT DIFFICULT TO HEAL WOUNDS IN SEVERE PROSTHETIC JOINT
INFECTIONS
Ciro Pempinello 1 , Aldo Bova 1 , Fiorella Martucci 2 , Raffaele Pempinello 2
1 Department of Orthopaedic and Traumatology – S.Gennaro Hospital (Napoli, Italy);
2 Department of Infectious Diseases – Cotugno Hospital (Napoli, Italy).
Aim: Treatment of soft tissue defects resulting from bone infections,when foreign
implants are involved, represents a major challenge.VAC therapy has recently been
used in orthopedic field for management of open wounds. The purpose of this study was
to evaluate the use of VAC Therapy to improve the outcome of high risk wounds in
critical patients affected by periprosthetic infections.
Methods: We observed 22 patients out of 36 affected by severe periprosthetic infections
with comorbidities, presenting difficult to heal wounds. These infections were treated
with 2 stage procedure, and VAC was applied. Targeted antibiotic long therapy was
administered. The study evaluated treatment for up to 16 weeks or till complete closure
was achieved compared with control group of 14 patients treated with conventional
dressing. Size of wound healing and time of closure were compared. No relapse was
observed in 22 patients(mean follow-up 24 months).
Results: 22 patients received VAC for 3 weeks. The sponge was inserted into the
wound cavity/periprosthetically at the pressure of 150mm Hg till sponge removal. A
better and more rapid control of the infection and reduced time to complete closure of
the wound was achieved in 19/22 patients treated with VAC compared with 5/14 patients
in control group.
Conclusion: VAC therapy would increase faster wound healing than treatment with
conventional dressing therapy. Based on our data, VAC shows an high infection
eradication rate with positive effect on wound healing and should be considered for high
risk wounds in patients affected by periprosthetic infections with comorbidities.
*VAC therapy
FREE PAPER SESSION: NEGATIVE PRESSURE WOUND THERAPY
169
Free Paper Session: Negative Pressure Wound Therapy
THE ROLE OF VACUUM IN THE TREATMENT OF METHICILLIN-RESISTANT DEEP
STERNAL WOUND INFECTION
Marisa De Feo 1 , Veronica D›Oria 1 , Ester Della Ratta 1 , Marco Montibello 1 ,
Alessandro Della Corte 1 , Pasquale Santè 1 , Gianantonio Nappi 1
1 Dpt Cardiothoracic Science Second University of Naples (Naples, Italy).
Aim: To review our experience with two alternative treatments of deep sternal wound
infections (DSWI), focusing on methicillin-resistant staphylococcal infections.
Methods: Between 2009 and 2012, 35 patients with post-cardiotomy DSWI were
primarily treated by NPWT*. In 24 of them the etiology was staphylococcal (Group A).
Comparisons were performed with 30 previous staphylococcal DSWI patients who
received closed mediastinal irrigation with antibiotic solution (Group B). The prevalence
of methicillin-resistance was:groups A=68.5%, B=56.7%. Hospital-stay and time between
DSWI treatment initiation and wound healing were compared between the two groups.
Results: One Group B patient died during DSWI treatment. The median healing time
was 14 days in Group A (mean 15.5±3.2), 18 (mean 21.2±16.4) in Group B (p=0.03).
DSWI did not recur following NPWT* treatment, while 7 patients had recurrence in Group
B (24%). Hospital-stay was significantly shorter in Group A (median 27.5 days, mean
29.2±11.3 versus 45, 49.2±19.3; p