Retrospective study of the efficacy of vascularized tissue transfer for treating antibiotic-resistant bacteria-infected wound

Abstract

If wounds are infected with bacteria resistant to an empirical antibiotic regimen, effective wound treatment will be delayed. This can delay wound healing and lengthen hospital stays, increasing the costs to patients. Long-term antibiotic use can also result in minor and major complications, such as diarrhea, antibiotic resistance, or life-threatening leukopenia. Multidrug-resistant (MDR) bacteria make wound treatment even more difficult. Traditionally, surgeons thought that adequate infection control should be established before soft tissue coverage. However, wounds infected by MDR do not heal well with this traditional method and there are no optimal treatment guidelines for MDR bacteria-contaminated wounds. We reviewed 203 patients who underwent vascularized flap surgery from 2012 to 2019 to cover wounds. Class IV and I wounds were compared according to the Centers for Disease Control and Prevention classification. Class IV was further classified as antibiotic-resistant (ARB) and antibiotic-sensitive (ASB) bacteria. Wound size, mode, location, pathogens, healing time, and basic demographics were evaluated. Data were compared using Cramer's V and one-way ANOVA or independent t tests. The average healing time was longer in the ARB (19.7 [range 7–44] days) and ASB (17.9 [range 2–36] days) groups than in the Clean group (16.5 [range 7–28] days). Healing time differed in the 3 groups ( P = .036). It was longer in the class IV group than in the class I group ( P = .01). However, it was not statistically different between the ARB and ASB groups ( P = .164). In our study the difference in healing time was small when vascularized tissue transfer was done in ARB-infected wound compared with ASB-infected and clean wound. It is necessary to perform surgery using vascularized tissue for the infected wound of antibiotic-resistant bacteria.

Resurfacing defects from mycobacterial skin and soft tissue infections using thoracodorsal artery perforator free flaps

“…If the wound is infected with bacteria resistant to empirical antibiotics or if the wound is complex involving structures other than soft tissue, effective treatment will be delayed. As a result, the wound healing and hospitalization period of patients can be prolonged, which increases overall cost [11]. Long-term hospitalization and antibiotic use increase the incidence of various complications such as gastrointestinal problems, antibiotic resistance, and leukopenia [15].…”

“…Many studies have explored reconstruction of various compound and complex defects after infection. Good results have been obtained using microsurgical free tissue transfer as an advanced method [10][11][12]. For refractory mycobacterial SSTIs, however, treatment including such reconstruction has not been suggested; thus, in this study, we present a series of radical resections and reconstructions using a thoracodorsal artery perforator (TDAP) free flap as a resurfacing surgical strategy.…”