title: Source Control and Graft Preservation Using Negative Pressure Wound Therapy with Antibiotic Instillation: A Case Report.
abstract: Negative pressure wound therapy (NPWT) is widely used to treat many types of complex wounds, and the advent of the instillation and dwell time (NPWTi-d) technique has enhanced this system with the addition of automated treatment with topical solutions. In the field of vascular surgery, NPWT is utilized to help close wounds over underlying grafts; however keeping these wounds free of infection and avoiding large reoperation when infection occurs remains a challenge. In this case report we present a patient who required acute intervention for limb ischemia, with a large wound created in the groin for anastomosis of a prosthetic graft bypass. Postoperatively, the wound became infected, and the challenge became balancing infection control and graft preservation with the patient's multiple comorbidities including postoperative non-ST segment elevation myocardial infarction (NSTEMI). To avoid a large reoperation, we chose NPWTi-d with automated instillation of an antibiotic solution. There was no reinfection or return to the operating room (OR), the patient was discharged after four weeks and the wound closed on its own shortly thereafter. This case demonstrates that for high-risk surgical patients with known wound infections in the proximity of a bypass graft, NPWTi-d with antibiotic instillation may be an effective augmentation to current treatment strategies and may be considered as a stand-alone technique for wound closure in select cases.
authors.affiliation: General Surgery, Mount Sinai Beth Israel.
authors.forename: Victoria
authors.initials: V
authors.lastname: Gilbert
authors.affiliation: General Surgery, Mount Sinai Beth Israel.
authors.forename: Timothy
authors.initials: T
authors.lastname: Kelly
authors.affiliation: Vascular Surgery, Mount Sinai Beth Israel.
authors.forename: Robert
authors.initials: R
authors.lastname: Grossi
keywords: bypass grafts; complex wounds; negative pressure wound therapy with instillation