Microdeformational wound therapy: A novel option to salvage complex wounds associated with the Nuss procedure
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Read the article on jpedsurg.org ↗Article · Apr 2019 · 1 min read
In brief
In brief
This operative technique describes using microdeformational wound therapy to manage complex suppurative wounds following Nuss procedure for pectus excavatum repair. The approach allows salvage of the implanted bar through controlled wound debridement and MDWT application (average 39 days), potentially avoiding implant removal and recurrent deformity.
Written by the GCMD Library team from the article.
Background
Complex wounds associated with the Nuss procedure are a resource intensive complication that may lead to significant morbidity with potential removal of the implanted device and abandonment of the repair. We report our management technique of this complication utilizing microdeformational wound therapy (MDWT) that is safe, is efficacious and allows for salvage of the repair.
Operative technique
We defined a complex wound as a wound that became suppurative and drained in the postoperative period and failed to resolve with a trial of conventional wound management and antibiotics. Upon recognition of a complex wound, we recommend an initial operative wound debridement. This allows wound cultures, wound assessment and precise initiation of MDWT. It is not uncommon to have exposed hardware in the wound early in the course of therapy. Metal allergy must be excluded. The patient is transitioned to oral antibiotics following resolution of the acute process. MDWT is performed until the wounds are completely epithelialized with no clinical signs of drainage or infection. The average length of MDWT in our patients was 39 days. Following complete wound healing the patients are maintained on antibiotics until implant removal.
Conclusions
The use of microdeformational wound therapy in complex wounds associated with the Nuss procedure is a safe and effective modality. The technique may reduce the likelihood of implant removal with potential recurrent pectus excavatum.
Type of study
Operative technique.
Level of evidence
Level IV, case series with no comparison group