A Combination Therapy Case Study: Utilizing Negative Pressure Wound Therapy and Cryopreserved Human Skin Allograft for the Treatment of a Chronic Achilles Wound Secondary to Suture Bridge Rejection with Concurrent Infection

Abstract Body: Problem: A 57-year-old diabetic female presented with a nonhealing surgical wound five months after the index achilles tendon debridement and repair with a suture bridge.  The wound spit suture multiple times over the five-month period. The wound became infected and was complicated by multiple incisions over the achilles tendon insertion, an area known for wound complications. CT and MRI showed an abscess as well as possible osteomyelitis. The clinical picture was further complicated by the recent implantation of suture anchors and suture bridge system. Solution and Discovery: Care of the patient was assumed as an inpatient. Advanced imaging was obtained and the decision was made to take the patient to the OR for an incision and drainage with excision of as much of the involved infected hardware possible with negative pressure wound therapy application. A percutaneous bone biopsy was also performed through a clean site to obtain a sample of the calcaneus to rule out osteomyelitis and came back negative. Deep wound and suture cultures grew out MSSA. The patient underwent serial washouts with NPWT. At seven weeks postop, a healthy granular base was appreciated and a cryopreserved human skin allograft was utilized with bolster dressing. The patient underwent regular dressing changes and the graft incorporated without issue. Five weeks after the cryopreserved human skin allograft application, the wound had healed completely. Points of Learning: With complex, chronic, surgical wounds multiple wound care modalities can be used to generate healing synergy. In this case, negative pressure wound therapy created a healthy wound bed for a cryopreserved human skin allograft to be applied. Immobilization and protection of a wound are essential, especially in the lower extremity. In this case a CAM boot was utilized to reduce the motion of the skin and strain on the wound to allow for healing.