Articles | Volume 8, issue 3
https://doi.org/10.5194/jbji-8-165-2023
© Author(s) 2023. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
https://doi.org/10.5194/jbji-8-165-2023
© Author(s) 2023. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
The antibiotic bead pouch – a useful technique for temporary soft tissue coverage, infection prevention and therapy in trauma surgery
Markus Rupp
CORRESPONDING AUTHOR
Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
Nike Walter
Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
Dominik Szymski
Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
Christian Taeger
Plastische Chirurgie & Ästhetik an der Isar, Widenmayerstraße 16, 80538 Munich, Germany
Martin Franz Langer
Department of Trauma, Hand and Reconstructive Surgery, Waldeyerstrasse 1, 48149 Muenster, Germany
Volker Alt
Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
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Cited articles
Behrend, R.: Gentamicin-polymethylmethacrylate chains in the treatment
of infected cardiac pacemaker pouches – two case reports, Recons.
Surg., 20, 101–104, 1988.
Bowyer, G.: Antibiotic impregnated beads in open fractures. A report on
the technique and possible applications in military surgery, BMJ Military
Health, 139, 100–104, 1993.
Bratzler, D. W. and Houck, P. M.: Antimicrobial prophylaxis for surgery: an
advisory statement from the National Surgical Infection Prevention Project,
Clin. Infect. Dis., 38, 1706–1715, 2004.
Buchholz, H.: Uber die Depotwirkung einiger Antibiotika bei Vermischung
mit dem Kunstharz Palacos, Chirurg, 40, 511–515, 1970.
Chaudhary, S., Sen, R., Saini, U. C., Soni, A., Gahlot, N., and Singh, D.: Use of
gentamicin-loaded collagen sponge in internal fixation of open fractures,
Chinese Journal of Traumatology, 14, 209–214, 2011.
Depypere, M., Kuehl, R., Metsemakers, W.-J., Senneville, E., McNally, M. A., Obremskey, W. T., Zimmerli, W., Atkins, B. L., and Trampuz, A.: Recommendations for
Systemic Antimicrobial Therapy in Fracture-Related Infection: A Consensus
From an International Expert Group, J. Orthop. Trauma, 34, 30–41, https://doi.org/10.1097/BOT.0000000000001626, 2020.
Garner, M. R., Sethuraman, S. A., Schade, M. A., and Boateng, H.: Antibiotic prophylaxis
in open fractures: evidence, evolving issues, and recommendations.
J. Am. Acad. Orthop. Sur., 28, 309–315, 2020.
Geurts, J. and Walenkamp, G.: PMMA beads and spacers for local antibiotic administration, in: Management of periprosthetic joint infections (PJIs), Woodhead Publishing, 219–230, 2017.
Gosain, A., Chang, N., Mathes, S., Hunt, T. K., and Vasconez, L.: A study of the
relationship between blood flow and bacterial inoculation in
musculocutaneous and fasciocutaneous flaps, Plast. Reconstr,
Surg., 86, 1152–1162, 1990.
Gustilo, R. B. and Anderson, J. T.: Prevention of Infection in the Treatment of
One Thousand and Twenty-five Open Fractures of Long Bones, J.
Bone Joint Surg., 58-A, 453–458, 1976.
Haidari, S., Ijpma, F. F., Metsemakers, W.-J., Maarse, W., Vogely, H. C., Ramsden, A. J., McNally, M. A., and Govaert, G. A.: The role of
negative-pressure wound therapy in patients with fracture-related infection:
a systematic review and critical appraisal, BioMed Res. Int.,
2021, 1–11, 2021.
Henry, S. L., Ostermann, P., and Seligson, D.: The prophylactic use of antibiotic
impregnated beads in open fractures, J. Trauma, 30, 1231–1238, 1990.
Henry, S. L., Ostermann, P., and Seligson, D.: The antibiotic bead pouch
technique. The management of severe compound fractures, Clin.
Orthop. Rel. Res., 295, 54–62, 1993.
Investigators, F., Bhandari, M., Jeray, K. J., Petrisor, B. A., Devereaux, P. J., Heels-Ansdell, D., Schemitsch, E. H., Anglen, J., Della Rocca, G. J., Jones, C., Kreder, H., Liew, S., McKay, P., Papp, S., Sancheti, P., Sprague, S., Stone, T. B., Sun, X., Tanner, S. L., Tornetta 3rd, P., Tufescu, T., Walter, S., and Guyatt, G. H.: A Trial of Wound
Irrigation in the Initial Management of Open Fracture Wounds, N. Engl. J. Med.,
373, 2629–2641, 2015.
Ismat, A., Walter, N., Baertl, S., Mika, J., Lang, S., Kerschbaum, M., Alt, V., and Rupp, M.: Antibiotic cement coating in
orthopedic surgery: a systematic review of reported clinical techniques,
J. Orthop. Traumatol., 22, 1–20, 2021.
Keating, J., Blachut, P., O'Brien, P., Meek, R., and Broekhuyse, H.: Reamed nailing
of open tibial fractures: does the antibiotic bead pouch reduce the deep
infection rate?, J. Orthop. Trauma, 10, 298–303, 1996.
Klemm, K.: The treatment of infected osteosynthesis using
gentamycin-PMMA-bead chains, Hefte zur Unfallheilkunde, 138, 197–200, 1979.
Ktistakis, I., Giannoudi, M., and Giannoudis, P. V.: Infection rates after open
tibial fractures: are they decreasing?, Injury, 45, 1025, https://doi.org/10.1016/j.injury.2014.03.022, 2014.
Kühn, K.-D., Renz, N., and Trampuz, A.: Lokale antibiotikatherapie, Der
Unfallchirurg, 120, 561–572, 2017.
Lenarz, C. J., Watson, J. T., Moed, B. R., Israel, H., Mullen, J. D., MacDonald, J. B.:
Timing of wound closure in open fractures based on cultures obtained after
debridement, J. Bone Joint Surg. Am., 92, 1921–1926, 2010.
Lowenberg, D. W., Rupp, M., and Alt, V.: Understanding and treating chronic osteomyelitis, in: Skeletal trauma: basic science, management, and reconstruction. Elsevier, edited by: Browner, J. J. B. D., Krettek, C., and Anderson, P. A., Elsevier, 2019.
Malchau, K. S., Tillander, J., Zaborowska, M., Hoffman, M., Lasa, I., Thomsen, P., Malchau, H., Rolfson, O., and Trobos, M.: Biofilm properties in
relation to treatment outcome in patients with first-time periprosthetic hip
or knee joint infection, Journal of Orthopaedic Translation, 30, 31–40, 2021.
Marchand, L. S., Sprague, S., O'Hara, N. N., Li, C. S., O'Toole, R. V., Joshi, M., Viskontas, D., Romeo, N., Hymes, R. A., and Obremskey, W. T.: Local administration of
vancomycin powder in orthopaedic fracture surgery: current practice and
trends, OTA Int., 21, e223, https://doi.org/10.1097/OI9.0000000000000223, 2023.
Metsemakers, W.-J., Morgenstern, M., Senneville, E., Borens, O., Govaert, G. A., Onsea, J., Depypere, M., Richards, R. G., Trampuz, A., Verhofstad, M. H.: General
treatment principles for fracture-related infection: recommendations from an
international expert group, Arch. Orthop. Traum. Su., 140, 1013–1027, https://doi.org/10.1007/s00402-019-03287-4, 2019.
Mielke, M. and Hansis, M.: Prävention postoperativer Wundinfektionen, Bundesgesundheitsbl., 61, 371–373, https://doi.org/10.1007/s00103-018-2721-3, 2018.
Morgenstern, M., Vallejo, A., McNally, M., Moriarty, T., Ferguson, J., Nijs, S., and Metsemakers, W.: The effect of local
antibiotic prophylaxis when treating open limb fractures: A systematic
review and meta-analysis, Bone Joint Res., 7, 447–456, 2018.
Moriarty, T. F., Metsemakers, W.-J., Morgenstern, M., Hofstee, M. I., Vallejo Diaz, A., Cassat, J. E., Wildemann, B., Depypere, M., Schwarz, E. M., and Richards, R. G.: Fracture-related
infection, Nat. Rev. Dis. Primers, 8, 67, https://doi.org/10.1038/s41572-022-00396-0, 2022.
Oliver, R. A., Lovric, V., Christou, C., Aiken, S. S., Cooper, J. J., and Walsh, W. R.:
Application of calcium sulfate for dead space management in soft tissue:
characterisation of a novel in vivo response, BioMed Res. Int., 2018, 8065141, https://doi.org/10.1155/2018/8065141,
2018.
Omar, M., Zeckey, C., Krettek, C., and Graulich, T.: Offene Frakturen, Der
Unfallchirurg, 124, 651–665, 2021.
Ostermann, P., Henry, S., and Seligson, D.: Treatment of 2d and 3d degree
complicated tibial shaft fractures with the PMMA bead pouch technic, Der
Unfallchirurg, 92, 523–530, 1989.
Ostermann, P. A., Henry, S. L., and Seligson, D.: Timing of wound closure in severe
compound fractures, SLACK Incorporated Thorofare, NJ, 397–399, 1994.
Papakostidis, C., Kanakaris, N. K., Pretel, J., Faour, O., Morell, D. J., and Giannoudis, P. V.: Prevalence of complications of open tibial shaft fractures stratified
as per the Gustilo–Anderson classification. Injury, 42, 1408–1415,
2011.
Patterson, J. T., Becerra, J. A., Brown, M., Roohani, I., Zalavras, C., Carey, J. N.:
Antibiotic bead pouch versus negative pressure wound therapy at initial
management of AO/OTA 42 type IIIB open tibia fracture may reduce fracture
related infection: A retrospective analysis of 113 patients, Injury,
54, 744–750, 2023.
Pincus, D., Byrne, J. P., Nathens, A. B., Miller, A. N., Wolinsky, P. R., Wasserstein, D., Ravi, B., and Jenkinson, R. J.: Delay in Flap Coverage Past 7
Days Increases Complications for Open Tibia Fractures: A Cohort Study of 140
North American Trauma Centers, J. Orthop. Trauma, 33, 161–168, 2019.
Rand, B. C. and Wenke, J. C.: An Effective Negative Pressure Wound
Therapy–Compatible Local Antibiotic Delivery Device, J. Orthop. Trauma, 31, 631–635, 2017.
Robinson, D., On, E., Hadas, N., Halperin, N., and Hofman, S.: Microbiologic flora
contaminating open fractures: its significance in the choice of primary
antibiotic agents and the likelihood of deep wound infection, J. Orthop. Trauma, 3, 283–286, 1989.
Rupp, M., Kern, S., Weber, T., Menges, T. D., Schnettler, R., Heiß, C., and Alt, V.: Polymicrobial infections and
microbial patterns in infected nonunions – a descriptive analysis of 42
cases, BMC Infectious Diseases, 20, 1–8, 2020.
Rupp, M., Baertl, S., Walter, N., Hitzenbichler, F., Ehrenschwender, M., and Alt, V.: Is There a Difference in Microbiological Epidemiology and Effective Empiric
Antimicrobial Therapy Comparing Fracture-Related Infection and
Periprosthetic Joint Infection? A Retrospective Comparative Study,
Antibiotics, 10, 921, https://doi.org/10.3390/antibiotics10080921, 2021.
Rupp, M., Kern, S., Walter, N., Anastasopoulou, L., Schnettler, R., Heiss, C., and Alt, V.: Surgical treatment outcome after
serial debridement of infected nonunion – A retrospective cohort study,
Eur. J. Orthop. Surg. Tr., 32, 183–189, 2022.
Seligson, D., Ostermann, P., Henry, S. L., and Wolley, T.: The management of open
fractures associated with arterial injury requiring vascular repair,
J. Trauma, 37, 938–940, 1994.
Slane, J., Gietman, B., and Squire, M.: Antibiotic elution from acrylic bone
cement loaded with high doses of tobramycin and vancomycin, J.
Orthop. Res., 36, 1078–1085, 2018.
Stanton, C.: Guideline for preoperative patient skin antisepsis, AORN
J., 113, P5–P7, 2021.
Stinner, D. J., Hsu, J. R., and Wenke, J. C.: Negative pressure wound therapy reduces
the effectiveness of traditional local antibiotic depot in a large complex
musculoskeletal wound animal model, J. Orthop. Trauma,
26, 512–518, 2012.
Sweere, V., Sliepen, J., Haidari, S., Depypere, M., Mertens, M., Ijpma, F., Metsemakers, W.-J., and Govaert, G.: Use of negative pressure wound
therapy in patients with fracture-related infection more than doubles the
risk of recurrence, Injury, 53, 3938–3944, 2022.
Wahlig, H., Dingeldein, E., Bergmann, R., and Reuss, K.: The release of gentamicin
from polymethylmethacrylate beads. An experimental and pharmacokinetic
study, J. Bone Joint Surg., 60, 270–275, 1978.
Walter, N., Rupp, M., Hierl, K., Pfeifer, C., Kerschbaum, M., Hinterberger, T., and Alt, V.: Long-term patient-related quality
of life after fracture-related infections of the long bones, Bone Joint
Res., 10, 321–327, 2021a.
Walter, N., Rupp, M., Lang, S., and Alt, V.: The epidemiology of fracture-related
infections in Germany, Sci. Rep.-UK, 11, 1–7, 2021b.
Wang, H., Liu, Y., Shi, Z., Wang, D., Zhang, H., Diao, S., Xu, X., Waheed, M. Z., Lu, T., and Zhou, J.: Intrawound application of vancomycin
reduces the proportion of fracture-related infections in high-risk tibial
plateau fractures, Injury, 54, 1088–1094, 2023.
Warner, M., Henderson, C., Kadrmas, W., and Mitchell, D. T.: Comparison of
vacuum-assisted closure to the antibiotic bead pouch for the treatment of
blast injury of the extremity, Orthopedics, 33, 77–82, https://doi.org/10.3928/01477447-20100104-06, 2010.
Yusuf, E., Jordan, X., Clauss, M., Borens, O., Mäder, M., and Trampuz, A.: High
bacterial load in negative pressure wound therapy (NPWT) foams used in the
treatment of chronic wounds, Wound Repair Regen., 21, 677–681, 2013.
Zens, Y., Barth, M., Bucher, H. C., Dreck, K., Felsch, M., Groß, W., Jaschinski, T., Kölsch, H., Kromp, M., and Overesch, I.: Negative pressure wound therapy in
patients with wounds healing by secondary intention: a systematic review and
meta-analysis of randomised controlled trials, Systematic Reviews, 9, 1–26, 2020.
Short summary
The antibiotic bead pouch is a useful technique for temporary soft tissue coverage. After the introduction of negative wound pressure therapy, it has fallen into oblivion. However, the technique has several advantages, which are highlighted in the present review article. After debridement, the antibiotic beads deliver high dosages of antibiotics suitable for bone cements. This enables a sterile wound, which might help to avoid either infection or progress of infection.
The antibiotic bead pouch is a useful technique for temporary soft tissue coverage. After the...