Chronic draining sinus with Serratia in left ankle
Courtesy of Courtesy of Dr. Christopher P Demas
Professor and Chief, Division of Plastic Surgery, University of New Mexico, Albuquerque, New Mexico
69 year-old male presented with a complex history of his left ankle. The patient was initially treated for a left closed pilon fracture of the distal tibia with open reduction internal fixation. Over the following 13 years, the patient underwent ankle fusion, medial plantar island flap reconstruction due to wound breakdown, and several treatments for wound dehiscence. After an occurrence of wound dehiscence about the medial aspect of the ankle, the patient was hospitalised, an I&D was performed and cultures tested positive for MRSA. The patient underwent weekly wound care visits with daily packing changes at home.
In total, the patient endured fifteen surgeries prior to presenting with chronic draining sinus. He was hospitalised and cultures tested positive for Serratia.
Debridement of scarred skin, deep tissue and bone within the chronic osteomyelitis cavity was carried out to remove all non-viable tissue. STIMULAN paste was injected to fill the resulting dead space. The cavity was covered with a reverse sural flap and I.V. antibiotics were administered to treat the infection.
The patient underwent debridement satisfactorily with partial absorption of STIMULAN paste at 3 months. The patient was fully healed and free from infection 14 months after treatment, and remains infection free 2 years after treatment
For indications, contraindications, warnings and precautions see Instructions for Use. The treating physician is responsible for deciding the type and quantity of antibiotic used. Concurrent use of locally administered antibiotics may affect setting time.
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