From the Research
Antibiotic beads placed during ORIF surgery for an open femur fracture typically need to be surgically removed and are not designed to dissolve on their own. The presence of these beads in a non-healing wound one month post-operation requires immediate surgical intervention. Most commonly, these beads are made of polymethylmethacrylate (PMMA) impregnated with antibiotics like gentamicin, tobramycin, or vancomycin, which slowly release medication to treat or prevent infection at the surgical site. While the antibiotics elute from the beads over time (usually 2-4 weeks), the PMMA carrier material remains intact. The persistent presence of these beads may be contributing to the poor wound healing by acting as a foreign body. Management typically involves surgical debridement to remove the beads, assessment of the wound bed, possible tissue cultures to rule out infection, and potentially a new wound closure strategy. Some newer biodegradable antibiotic delivery systems do exist (such as calcium sulfate or certain polymer beads), but if the patient has traditional PMMA beads, these would require removal 1. The continued poor wound healing suggests a comprehensive wound assessment is needed, including evaluation for infection, vascular status, and nutritional factors that might be impeding proper healing. Key considerations in wound management include:
- Surgical debridement to remove any non-viable tissue and foreign bodies, such as antibiotic beads
- Assessment of the wound bed for signs of infection or other complications
- Possible tissue cultures to rule out infection
- Evaluation of vascular status and nutritional factors that might be impacting wound healing
- Consideration of newer biodegradable antibiotic delivery systems for future treatments. It's also important to note that bacteria play a significant role in wound healing, and all chronic wounds are colonized by bacteria, with low levels of bacteria being beneficial to the wound healing process 2. However, wound infection is detrimental to wound healing, and the diagnosis and management of wound infection is controversial, and varies between clinicians. The progression from wound colonization to infection depends not only on the bacterial count or the species present, but also on the host immune response, the number of different species present, the virulence of the organisms and synergistic interactions between the different species. Therefore, a comprehensive approach to wound management is necessary to promote optimal healing and prevent complications. In terms of specific treatments, there is some evidence to suggest that certain antiseptics and antibiotics may be effective in promoting wound healing, although the quality of the evidence is generally low 3. For example, one study found that sucralfate cream increased the likelihood of healing open wounds following haemorrhoidectomy compared to a petrolatum cream. However, more research is needed to fully understand the effectiveness of these treatments and to develop evidence-based guidelines for wound management. Overall, the management of non-healing wounds requires a comprehensive and multidisciplinary approach, taking into account the complex interplay of factors that can impact wound healing. By prioritizing the removal of foreign bodies, such as antibiotic beads, and addressing underlying factors that may be impeding healing, clinicians can promote optimal wound healing and improve patient outcomes.