Surgical wound dehiscence is a known postoperative complication that involves the breaking open of a surgical incision along the suture. This case report explores an effective treatment modality in a medically complicated patient. A 35-year-old woman presented following right great toe arthrodesis, metatarsal neck osteotomies, extensor tendon lengthening, and capsulotomy of the second, third, fourth, and fifth toes 2 weeks prior. She developed a wound dehiscence of the right great toe and subsequent exposure of surgical hardware, complicated by infection.
The traditional management of postoperative wound infection with hardware exposure has been serial irrigation and debridement, intravenous antibiotics, and the removal of the hardware. The authors report the case of a patient with rheumatoid arthritis (RA) with an open, infected surgical wound of the right great toe with exposed hardware following right great toe arthrodesis successfully treated without removal of exposed hardware and use of an epithelial matrix graft.
Treatment was initiated with prompt administration of intravenous vancomycin 1000 mg every 12 hours for 7 days and after. She continued the treatment with oral trimethoprim/sulfamethoxazole. Wound care involved twice daily Dakin’s solution (sodium hypochlorite; Century Pharmaceuticals, Inc) and dressing changes. Patient had also a course of 10 days of negative pressure wound therapy (NPWT), that was discontinued due to the poor suction and the difficulty to manage the secretions and the bed of the wound. At the admission, the foot X-ray showed moderate soft-tissue swelling of the great toe with soft-tissue emphysema consistent with cellulitis. Cytal 1-Layer Wound Matrix graft (ACell) was placed on the wound. The porcine urinary bladder matrix (UBM) has a unique bimodal surface that consists of an intact basement membrane and organized connective tissue comprised of urinary bladder lamina propria. This serves as a robust scaffold for cell infiltration and expedited wound healing.
UBM plus offloading with a total contact cast (TCC) versus standard care (nonadherent dressing with TCC) revealed a significantly reduced healing time and diminished rate of ulcer occurrence.
The UBM product’s MatriStem UBM (ACell) technology platform is based on an extracellular matrix derived from porcine bladder. The biocompatible constitution of the UBM consists of a motley of multiple types of carbohydrates, collagens, proteins, and other components.
The placement of the UBM in this patient with impediments to wound healing facilitated closure of the irregularly contoured wound without having to remove the exposed hardware. Wound healing was accomplished without removal of the exposed deep hardware in a patient with comorbidities and post-surgical wound dehiscence.