Management of Multiple Skeletal Tuberculosis Wounds Complicated With Multiple Deep Sinus Tracts

Abstract

BACKGROUND: Tuberculosis (TB) is a leading infectious disease worldwide. It rarely occurs in the scapula and toe joints and is easily misdiagnosed. Without prompt treatment, the associated lesions can spread to surrounding soft tissues such as joint capsules, muscles, tendons, and fascia. In severe cases, the bones and articular surfaces can become significantly damaged; it is not uncommon for deep skeletal TB wounds with sinus tracts to form, which are very difficult to treat. We report our successful wound care management approach for one patient with multiple skeletal TB complicated with multiple deep sinus tracts. CASE: The patient was treated with anti-TB medications, and wound and bone debridement (sharps, surgical) combined with vacuum-shielded drainage (VSD) (Kula, CG Bio Co Ltd, Gyeonggi-do, South Korea) to fill the sinus tract. We removed the caseous (cheese-like) necrotic tissue, purulent drainage, and necrotic tissue at the base of the wound to ensure optimal wound care. Throughout the course of treatment, we selected different types of dressings to maintain moist wound healing and absorb excessive drainage. After 144 days of treatment, the wound and deep sinus tracts completely healed. CONCLUSIONS: Wounds related to skeletal TB with multiple sinus tracts are difficult to manage and heal. We found our wound protocol that included timely debridement and use of VSD was effective for the management of these complex wounds. Specifically, our approach filled the dead space in the sinus tract, removed excessive drainage, promoted the growth of granulation tissue, and overall promoted tissue healing.