Treatment of Postoperative Wounds with Infected Implanted Hardware After Open Reduction and Internal Fixation of Fractures or Skeletal Stabilization with Plasma/Nitric Oxide Therapy Without Removal of the Hardware

Operative insertion of hardware has become a standard practice for the treatment of many fractures and stabilization of skeletal components following neurosurgical procedures. Unfortunately, postoperative infection of the wound and hardware occurs in about 100,000 cases annually (1) resulting in poor wound healing, delayed and abnormal union of the bones, significant morbidity, prolonged hospitalization, and significantly increased cost. (2,3)

Treatment of these infections is difficult because of the presence of the implant and bacteria in the form of a biofilm on the implant. (4,5) Many times the hardware must be removed resulting in problems securing the unstable skeletal components and adding to the recovery time and cost. (6) The use of plasma/nitric oxide therapy has been found to be beneficial in treating these problems without reopening operative wounds or removing implanted devices.

The nitric oxide is generated from the surrounding air, and the molecules are attached to a plasma energy stream so that the molecules can be delivered to the tissues with good therapeutic effect. This plasma energy/nitric oxide stream will penetrate intact skin up to 3 cm deep allowing treatment without opening the skin. This, also, allows the stream to penetrate biofilms and kill the bacteria. During the treatment, no part of the device touches the patient so there is no need for disposable parts or sterilization of the device.

Nitric oxide is effective against all bacteria with no organisms known to be resistant to its effects. (7,8) Treatment is painless, and no adverse reactions have been encountered. We have treated a series of 10 patients with infected postoperative wounds containing implanted hardware with the plasma energy/nitric oxide therapy without opening the operative wound or removing the device. Each patient was treated with the plasma energy/nitric oxide once per week for an average of 6 minutes per treatment. All patients healed with no one requiring removal of the hardware. Further details of the treatment will be presented.