DOS 2020

232 · DOS Abstracts Limb salvage utilizing ring fixation and negative pressure wound therapy with instillation Juozas Petruskevicius, Jan Duedal Rölfing Department of Orthopedic Surgery, Aarhus University Hospital Background: Negative pressure wound therapy with instillation (NPWTi) di- minishes the number of bacteria in chronic wounds and is thus effective in its treatment, the more so when soft tissue defects are substantial (Goss 2014, Lessing 2011). Purpose / Aim of Study: Case report Materials and Methods: A 56-year-old man with diabetic ulcer of the heel (Ø 6 cm) and osteomyelitis of the calcaneus presented with a bimalleolar fracture and acute cellulitis. The limb was scheduled for amputation due to the severity of the 3 concomitant local threats to the limb in conjunction with dis-regulated diabetes, micro- and macroangiopathy, neurophathy, BMI = 44, depression and colostomy. The toe pressure was 65 mmHg. Open reduction and internal fixa- tion was not a viable option, however the patient refused amputation. Findings / Results: Initial treatment consisted of wound debridement, span- ning the ankle with external ring fixation, and intravenous antibiotics. Kamme biopsies verified Enterococcus faecalis, Proteus mirabilis and Escherichia coli. NPWTi treatment (V.A.C. VERAFLO™) was initiated after 7 days. NPWTi treat- ment consisted of Cleanse Choice™ dressings and instillation of 20 ml isoton- ic saline solution for 10 min followed by 210 min of NPWT with 125 mmHg. Vacuum dressings were changed every 3-4 days. After 11 days of NPWTi the ulcer and the exposed calcaneus were covered by granulation tissue and split skin transplantation was performed. Ring fixation spanning the ankle joint with weightbearing as tolerated continued for 11 weeks in total facilitating fracture- and soft tissue healing. At frame removal, additional screw fixation of medial malleolus was performed to allow full weightbearing after 2 weeks of immobi- lization in a cast. Conclusions: The combined effect of NPWTi, ring fixation and IV-antibiotics salvaged the limb despite severe local (acute ankle fracture, chronic foot ulcer and severe erysipelas) and systemic threats (dysregulated diabetes incl. neu- ropathy, colostomy, obesity). In the present case, NPWTi was effective in the management of a severe, multibacterial wound infection and provided contin- ued postsurgical debridement and granulation within a short time frame of less than two weeks. 211.