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The treatment of complex wounds is commonplace for plastic surgeons. Standard management is debridement of infected and devitalized tissue and systemic antibiotic therapy. In cases where vital structures are exposed within the wound, coverage is obtained with the use of vascularized tissue using both muscle and fasciocutaneous flaps. The use of nondissolving polymethylmethacrylate and absorbable antibiotic-impregnated beads has been shown to deliver high concentrations of antibiotics with low systemic levels of the same antibiotic. We present a multicenter retrospective review of all cases that used absorbable antibiotic-impregnated beads for complex wound management from 2003 to 2013. A total of 104 cases were investigated, flap coverage was used in 97 cases (93.3%). Overall, 15 patients (14.4%) required reoperation with the highest groups involving orthopedic wounds and sternal wounds. The advantages of using absorbable antibiotic-impregnated beads in complex infected wounds have been demonstrated with minimal disadvantages. The utilization of these beads is expanding to a variety of complex infectious wounds requiring high concentrations of local antibiotics.
The treatment of complex wounds is commonplace for plastic surgeons. A multitude of circumstances exist that contribute to developing acute or chronic complex wounds which include trauma with exposed bone, osteomyelitis, exposed orthopedic hardware, wound dehiscence, and infected grafts. Standard management of the infected wound is debridement of infected and devitalized tissue and antibiotic therapy.
In cases where vital structures are exposed within the wound, coverage is obtained with the use of vascularized tissue using both muscle and fasciocutaneous flaps.1-4 In addition to systemic antibiotic therapy, the use of nondissolving polymethylmethacrylate (PMMA) beads and absorbable antibiotic-impregnated beads have been shown to deliver high concentrations of antibiotics with low systemic levels of the same antibiotic.5 These devices elute therapeutic concentrations of antibiotic for weeks.5 The theoretical advantage of local delivery is high concentrations of antibiotic and low systemic levels. When the systemic antibiotic levels are low, this could avoid concentration-associated side effects. The use of absorbable antibiotic beads is preferred, as they do not require an additional operation for removal.6
The treatment of extracavitary prosthetic vascular graft infections with initial placement of PMMA beads in the wound has been described with adequate wound sterilization and graft preservation.7' 8 This has also been described in the salvage of infected left ventricular assist...