Wound Management News

NEW YORK CITY – Community-acquired methicillin-resistant Staphylococcus aureus increased worldwide during the last 10 years with the main manifestations being skin and soft tissue infections.

GLASGOW – A British military trauma surgeon presented findings here that support the current practice for the management of unsalvageable war-wounded lower limbs.

A 2-month-old infant girl presents to your clinic with persistent mottling of her right leg.(Figure 1) Her parents state that they noticed mottling on all of her extremities shortly after birth and were initially reassured that it was a normal finding. However, they are concerned that the mottling has resolved elsewhere but persists on her leg. She was full-term and otherwise appears healthy and is thriving. On skin examination, involving her right thigh and lower leg are nearly circumferential violaceous and pink, blanching, reticulated, smooth patches (Figure 1). Her involved thigh and calf also have smaller circumferences than her uninvolved leg. The mottling varies with temperature and activity but persists despite efforts to warm her leg.

A previously healthy 14-year-old boy presented to adolescent clinic with a 5-day history of a severe headache. He had been seen in clinic 3 days prior and was diagnosed with acute sinusitis, for which he was prescribed cefdinir. His pain was localized to left frontal forehead, left orbit and left cheek. He also reported bilateral clear rhinorrhea.

Six months after the earthquake that claimed hundreds of thousands of lives in Haiti, wave after wave of trauma-related infections resulting from amputations and surgeries performed in suboptimal conditions continue to plague specialists in all fields.

This month’s guest columnist is Elizabeth Dufort, MD.

There are conflicting data regarding the best approach for treating children who are colonized with community-associated methicillin-resistant Staphylococcus aureus, but incision and drainage may be enough for abscesses less than 5 cm, according a speaker at the National Foundation for Infectious Diseases’ 2010 Annual Conference on Antimicrobial Resistance in Bethesda, Md.

Discordance between Staphylococcus aureus isolates cultured from nasal and wound sites and discrepancies between nasal colonization status and incidence of recurrent infections among children suggested that nasal colonization may not be an accurate marker for predicting which children are at risk for recurrent community-associated methicillin-resistant Staphylococcus aureus skin infections.

Wound healing is a significant problem in orthopedics. GraftJacket tissue matrix (Wright Medical Technology, Inc, Arlington, Tenn), a novel acellular regenerative tissue matrix, has been designed to aid wound closure. A prospective, randomized study was initiated to determine the efficacy of this tissue product in wound repair compared with conventional treatment. Lower extremity wounds are refractile to healing in patients with diabetes mellitus. Therefore, researchers used diabetic foot ulcers to evaluate the efficacy of GraftJacket tissue matrix in wound repair. Only a single administration of the tissue matrix was required. After 1 month of treatment, preliminary results demonstrate that this novel tissue matrix promotes faster healing at a statistically significant rate over conventional treatment. Because wounds in this series of patients are deep and circulation around the wound is poor, the preliminary results suggest that this tissue matrix will be applicable to other types of orthopedic wounds.

Paul C. Peters Jr, MD