Negative Pressure Wound Therapy for the Treatment of Infected Wounds with Exposed Knee Joint After Patellar Fracture

Abstract

Case Report Free Sang Yang Lee, MD, PhD; Takahiro Niikura, MD, PhD; Masahiko Miwa, MD, PhD; Yoshitada Sakai, MD, PhD; Keisuke Oe, MD, PhD; Takahiro Fukazawa, MD; Yohei Kawakami, MD; Masahiro Kurosaka, MD, PhD Treatment of soft tissue defects with exposed bones and joints, resulting from trauma, infection, and surgical complications, represents a major challenge. The introduction of negative pressure wound therapy has changed many wound management practices. Negative pressure wound therapy has recently been used in the orthopedic field for management of traumatic or open wounds with exposed bone, nerve, tendon, and orthopedic implants. This article describes a case of a patient with a large soft tissue defect and exposed knee joint, in which negative pressure wound therapy markedly improved wound healing. A 50-year-old man presented with an ulceration of his left knee with exposed joint, caused by severe wound infections after open reduction and internal fixation of a patellar fracture. After 20 days of negative pressure wound therapy, a granulated wound bed covered the exposed bones and joint. To our knowledge, this is the first report of negative pressure wound therapy used in a patient with a large soft tissue defect with exposed knee joint. Despite the chronic wound secondary to infection, healing was achieved through the use of the negative pressure wound therapy, thus promoting granulation tissue formation and closing the joint. We suggest negative pressure wound therapy as an alternative option for patients with lower limb wounds containing exposed bones and joints when free flap transfer is contraindicated. Our result added to the growing evidence that negative pressure wound therapy is a useful adjunctive treatment for open wounds around the knee joint. Drs Lee, Niikura, Miwa, Sakai, Oe, Fukazawa, Kawakami, and Kurosaka are from the Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. Drs Lee, Niikura, Miwa, Sakai, Oe, Fukazawa, Kawakami, and Kurosaka have no relevant financial relationships to disclose. Treatment of soft tissue defects with exposed bones and joints, resulting from trauma, infection, and surgical complications, represents a major challenge. Multiple techniques to provide soft tissue cover, including local muscle flaps ^1,2 and free tissue transfer, ^3,4 have been developed to prevent joint infection and promote wound healing. However, local flap techniques are often limited due to poor vascularization and damage to the surrounding tissues. In addition, free tissue transfers may produce donor site morbidity and require late revisions. The introduction of negative pressure wound therapy has changed many wound management practices. Negative pressure wound therapy is based on creating negative pressure around a wound. The technique was introduced independently by 2 groups in the 1990s for the treatment of large, chronically infected wounds. ^5,6 Negative pressure wound therapy has more recently been used in orthopedics for management of traumatic or open wounds with exposed bone, nerve, tendon, and orthopedic implants. ^7–16 This article describes the use of negative pressure wound therapy for the treatment of a large soft tissue defect with exposed knee joint, caused by severe wound infection after open reduction and internal fixation of a patellar fracture. A 50-year-old man with diabetes presented with an ulceration of his left knee with exposed joint. He had sustained a closed transverse patella fracture to his left knee in a bicycle accident 5 months previously. At that time, he was treated with open reduction and internal fixation with tension band wiring. As displacement gradually occurred, he underwent revision surgery with tension band wiring and cerclage 4 weeks after the initial surgery. Five weeks after the revision, however, displacement occurred again, so re-revision surgery was performed with tension band wire technique using cannulated screws combined with cerclage wiring. One day postoperatively, the patient’s temperature rose to 40°C. He reported progressive swelling, increasing pain, and erythema in the region of the patella. Gradually, soft tissue necrosis around… Treatment of soft tissue defects with exposed bones and joints, resulting from trauma, infection, and surgical complications, represents a major challenge. The introduction of negative pressure wound therapy has changed many wound management practices. Negative pressure wound therapy has recently been used in the orthopedic field for management of traumatic or open wounds with exposed bone, nerve, tendon, and orthopedic implants. This article describes a case of a patient with a large soft tissue defect and exposed knee joint, in which negative pressure wound therapy markedly improved wound healing. A 50-year-old man presented with an ulceration of his left knee with exposed joint, caused by severe wound infections after open reduction and internal fixation of a patellar fracture. After 20 days of negative pressure wound therapy, a granulated wound bed covered the exposed bones and joint. To our knowledge, this is the first report of negative pressure wound therapy used in a patient with a large soft tissue defect with exposed knee joint. Despite the chronic wound secondary to infection, healing was achieved through the use of the negative pressure wound therapy, thus promoting granulation tissue formation and closing the joint. We suggest negative pressure wound therapy as an alternative option for patients with lower limb wounds containing exposed bones and joints when free flap transfer is contraindicated. Our result added...