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Use of Antibiotic Impregnated Absorbable Beads and Tissue Coverage of Complicated Wounds
Terris L. White, MD1, Alfred T. Culliford, IV, MD1, Martin Zomaya, MD1, Gary Freed, MD2, Christopher P. Demas, MD3.
1Staten Island University Hospital, Staten Island, NY, USA, 2Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA, 3University of New Mexico, Albuquerque, NM, USA.
BACKGROUND: The treatment of complex wounds is commonplace for plastic surgeons. Standard management is debridement of infected and devitalized tissue and systemic antibiotic therapy. In cases where vital structures are exposed within the wound, coverage is obtained with the use of vascularized tissue using both muscle and fascio-cutaneous flaps. The use of non-dissolving poly-methyl-methacrylate (PMMA) and absorbable antibiotic-impregnated beads has been shown to deliver high concentrations of antibiotics with low systemic levels of the same antibiotic.
METHODS: We present a multi-center retrospective review of all cases that utilized absorbable antibiotic impregnated beads for complex wound management from 2003 - 2013.
RESULTS: A total of 104 cases were investigated, flap coverage was used in 97 cases (93.3%). 15 patients (14.4%) required re-operation for infection with the highest groups involving orthopedic wounds and sternal wounds.
CONCLUSIONS: The advantages of using absorbable antibiotic-impregnated beads in complex infected wounds have been demonstrated with minimal disadvantages. The utilization of these beads is expanding to a variety of complex infectious wounds requiring high concentrations of local antibiotics.
  
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