Efficacy of a Urinary Bladder Matrix for Treating Wound Dehiscence With Hardware Exposure in a Patient With Rheumatoid Arthritis

Roger D. Bui, BSc; Kenrick Lam, MD; Vinod K. Panchbhavi, MD, FACS

Disclosures

Wounds. 2020;32(4):E27-E30. 

In This Article

Abstract and Introduction

Abstract

Objective: This case report explores an effective treatment modality in a medically complicated patient, with considerable wound dehiscence refractory to treatment with negative pressure wound therapy (NPWT).

Case Report: A 35-year-old woman with a past medical history of hypothyroidism, osteoporosis, and rheumatoid arthritis treated with tumor necrosis factor (TNF) alpha inhibitors and disease-modifying antirheumatic drugs presented to the clinic following right great toe arthrodesis, metatarsal neck osteotomies, extensor tendon lengthening, and capsulotomy of the second, third, fourth, and fifth toes 2 weeks prior, with wound dehiscence of the right great toe and subsequent exposure of surgical hardware, complicated by infection. At the 2-week postop, a urinary bladder matrix was placed on the wound following failed NPWT, which was in place for 10 days. At the 3-month follow-up, the wound was closed and without any drainage. Patient reported a significant reduction in pain (visual analogue scale: 3) with adherence to weight-bearing restrictions.

Conclusions: Wound healing was accomplished without removal of the exposed deep hardware in a patient with comorbidities and post-surgical wound dehiscence.

Introduction

Surgical wound dehiscence is a known postoperative complication that involves the breaking open of a surgical incision along the suture. Wound healing is reliant on a series of interactions among cells and cell mediators; any disruption to this cascade of interactions will cause impairment of the normal physiologic response to insult and increase the likelihood of wound dehiscence.[1] Treatment is further complicated in patients with rheumatoid arthritis (RA), a chronic, erosive inflammatory disease that has been known to impede wound healing and increase baseline risk for infection.[2,3] In addition, the exposure of orthopedic hardware from surgery acts as a nidus for microbes, further increasing the incidence of infection and impeding healing.[4] Consequently, the traditional management of postoperative wound infection with hardware exposure has been serial irrigation and debridement, intravenous antibiotics, and likely removal of hardware.[5] The authors report the case of a patient with RA with an open, infected surgical wound of the right great toe with exposed hardware following right great toe arthrodesis successfully treated without removal of exposed hardware and use of an epithelial matrix graft.

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