Retrospective Evaluation of Microbicidal Polymer Dressing for Reduction of Infection Following Post Deformity Correction Surgery

December 2018 | Volume 17 | Issue 12 | Case Reports | 1322 | Copyright © December 2018

Shital Pema DPM

Kettering, OH

Abstract
Pin site infections are a very common complication of external fixation, and unfortunately, no standard of care exists to effectively minimize the risk of infection. Various pin site care regimens with different methods of cleaning and dressing orthopedic percutaneous pin sites can be found. Little evidence exists as to which pin site care regimen best reduces infection rates. This retrospective case series introduces the potential of a new organic polymer in solvent (DuraDerm®), which when applied to a pin site, eradicates any organisms, and forms a flexible occlusive bandage that reduces the risk of microbe migration into the pin track site. J Drugs Dermatol. 2018;17(12):1322-1324.

INTRODUCTION

K-wires and metal pins are commonly used for exter- nal fixation in patients requiring provisional or definitive fixation.These pins protrude through the skin and create an avenue for migration of organisms. Anytime there is a break in the integrity of the skin, the risk of infection is increased. Pin site infections are a very common complication of external fixation, and unfortunately, the literature is scant on how to optimally minimize the risk of infection. An optimal dressing for pin track sites would have microbicidal properties in order to prevent infection but would also facili- tate healing. DuraDerm® is a new product consisting of organic polymers. When applied, DuraDerm eradicates any organisms it comes in contact with and then rapidly evaporates leaving an elastomeric, transparent, biodegradable, and occlusive dressing.The product has already been used on hundreds of wounds secondary to trauma, shave biopsies, and Mohs micrographic surgery, including on flap and full-thickness skin graft repairs.1,2 This is the first review evaluating its use for the reduction of infection post deformity correction and/or traumatic provisional surgery. Depending on the reference, pin track infection rates have been reported to range from 0% to 100%. A systematic review of the incidence of pin track infections associated with external fixa- tion published in 2016 revealed a cumulative pin track infection rate of 27%. This rate was defined as the inherent risk of any given research participant developing a pin track infection at a random pin or wire site during the course of treatment with external fixation.3 A 2016 review describes pin track infection as the most commonly expected problem, or even an almost inevitable complication, when using external fixation.4

Common Risk Factors in Patients Associated With Deformity Correction and/or Traumatic Provisional Surgery

The traditional nonsurgical accommodative treatment for diabetes-associated Charcot foot arthropathy has been unsuccessful in improving the quality of life in affected individuals. This has led to the growing interest in surgical correction of the acquired deformity with either “super construct” internal fixa- tion implants or fine-wire static circular external fixation. Pin site infection is common in this high-risk patient population. Risk factors for pin track infection are multi-factorial. Patient specific factors may include increased age, comorbidities (diabetes, immune disorder, vascular diseases), immune status, medications (corticosteroids), and smoking. Pin and procedure related risk factors are also multifactorial. These may include, length of operative procedure, pin insertion technique, pin placement sites, and skin tension around pin site.5

Role of Duraderm

DuraDerm is a 510K FDA cleared medical device indicated for providing a covering over minor wounds and scrapes that are clean and dry. The microbicidal liquid solution consists of organic polymers. The unique formulation eradicates any organisms (bacteria, fungi, viruses) it comes in contact with. This is a result of the solvent’s activity against an infinite number of organisms. After eradication is complete, the solvent then tran- sitions into a clear, elastomeric, non-odorous film for covering disrupted tissue. The film protects the wound against entry of water, dirt, and germs. The film is elastomeric and protects in difficult regions where flexing, bending and creasing skin occurs. The clear film forms in less than a minute.6 DuraDerm should not be used to the treat deep infected wounds. Dura-