Case Description. A 2.5-year-old female spayed mixed breed dog presented to the Teaching Hospital for draining tracts on the left medial aspect of the tibia. Two years prior to presentation, the patient sustained a left tibial fracture, which was repaired with an intramedullary (IM) pin and two cerclage wires. Multiple antimicrobials were utilized during this time. Clinical Findings. Radiographs were consistent with left tibial osteomyelitis. The implant was removed and the wound was debrided. Treatment and Outcome. A bone window on the medial aspect of the tibia was created in order to facilitate implant removal. The wound and associated bone window were treated with vacuum assisted closure (VAC) in preparation for reconstructive surgery. Adjunctive VAC therapy was utilized following the caudal sartorius myocutaneous flap. Complications following this surgery included distal flap necrosis and donor site dehiscence. Clinical Relevance. This presents a difficult case of canine osteomyelitis with subsequent wound care in which VAC and a myocutaneous flap were useful adjunctive treatments for osteomyelitis. This is the first report of VAC in the management of canine osteomyelitis and management with a myocutaneous flap. 1. Introduction Muscle is the most versatile tissue for reconstructive surgery and is used in a variety of reconstructive surgical procedures ranging from soft tissue to orthopedics. Muscle flaps, for the most part, are easily dissected and are harvested with little donor site morbidity [1]. Donor muscle selection is based on the dimensions of the defect and function or purpose of the reconstructive procedure and can be harvested alone or as a composite flap (skin and muscle) [2–4]. Muscle flaps augment vascular supply of compromised wounds by inducing angiogenesis, which is used for the management of chronic osteomyelitis, shearing wounds to the distal extremities, decubital ulcers, and ablative oncological procedures [3–5]. The increased blood supply through transferred muscle enhances the host defense mechanism to a compromised wound by increasing local concentrations of immunoglobulins, complement, neutrophils, and oxygen tension [2, 6]. The use of vacuum assisted closure (VAC) therapy is well described as an alternative strategy in the management of a variety of wounds encountered in human medicine and surgery [7–11]. The uses of VAC therapy in human surgery include decubital ulcers, degloving injuries, distal extremity wounds, as a means to secure split thickness skin grafts in anatomically challenging areas, poststernotomy dehiscence
References
[1]
J. M. Miller, O. I. Lanz, and D. A. Degner, “Rectus abdominis free muscle flap for reconstruction in nine dogs,” Veterinary Surgery, vol. 36, no. 3, pp. 259–265, 2007.
[2]
S.-L. Chen, T.-M. Chen, T.-D. Chou, S.-C. Chang, and H.-J. Wang, “Distally based sural fasciomusculocutaneous flap for chronic calcaneal osteomyelitis in diabetic patients,” Annals of Plastic Surgery, vol. 54, no. 1, pp. 44–48, 2005.
[3]
M. J. Weinstein, M. M. Pavletic, and R. J. Boudrieau, “Caudal sartorius muscle flap in the dog,” Veterinary Surgery, vol. 17, no. 4, pp. 203–210, 1988.
[4]
D. A. Degner and R. Walshaw, “Medial saphenous fasciocutaneous and myocutaneous free flap transfer in eight dogs,” Veterinary Surgery, vol. 26, no. 1, pp. 20–25, 1997.
[5]
Z. Eyileten, A. R. Akar, S. Eryilmaz et al., “Vacuum-assisted closure and bilateral pectoralis muscle flaps for different stages of mediastinitis after cardiac surgery,” Surgery Today, vol. 39, no. 11, pp. 947–954, 2009.
[6]
D. P. Lew and F. A. Waldvogel, “Current concepts: osteomyelitis,” The New England Journal of Medicine, vol. 336, no. 14, pp. 999–1007, 1997.
[7]
L. C. Argenta and M. J. Morykwas, “Vacuum-assisted closure: a new method for wound control and treatment: Clinical experience,” Annals of Plastic Surgery, vol. 38, no. 6, pp. 563–576, 1997.
[8]
M. J. Morykwas, L. C. Argenta, E. I. Shelton-Brown, and W. McGuirt, “Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation,” Annals of Plastic Surgery, vol. 38, no. 6, pp. 553–562, 1997.
[9]
C. M. Sciortino, G. S. Mundinger, D. P. Kuwayama, and S. C. Yang MS Sussman, “Case report: treatment of severe subcutaneous emphysema with a negative pressure wound therapy dressing,” Eplasty, vol. 9, article e1, 2009.
[10]
A. J. DeFranzo, L. C. Argenta, M. W. Marks et al., “The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone,” Plastic and Reconstructive Surgery, vol. 108, no. 5, pp. 1184–1191, 2001.
[11]
Y. Tan, X. Wang, H. Li et al., “The clinical efficacy of the vacuum-assisted closure therapy in the management of adult osteomyelitis,” Archives of Orthopaedic and Trauma Surgery, vol. 131, no. 2, pp. 255–259, 2011.
[12]
R. Ben-Amotz, O. I. Lanz, J. M. Miller, D. E. Filipowicz, and M. D. King, “The use of vacuum-assisted closure therapy for the treatment of distal extremity wounds in 15 dogs,” Veterinary Surgery, vol. 36, no. 7, pp. 684–690, 2007.
[13]
M. Demaria, B. J. Stanley, J. G. Hauptman et al., “Effects of negative pressure wound therapy on healing of open wounds in dogs,” Veterinary Surgery, vol. 40, no. 6, pp. 658–669, 2011.
[14]
A. E. Guille, L. W. Tseng, and R. J. Orsher, “Use of vacuum-assisted closure for management of a large skin wound in a cat,” Journal of the American Veterinary Medical Association, vol. 230, no. 11, pp. 1669–1673, 2007.
[15]
C. Mullally, K. Carey, and R. Seshadri, “Use of a nanocrystalline silver dressing and vacuum-assisted closure in a severely burned dog,” Journal of Veterinary Emergency and Critical Care, vol. 20, no. 4, pp. 456–463, 2010.
[16]
S. J. Ford, S. Rathinam, J. E. King, and R. Vaughan, “Tuberculous osteomyelitis of the sternum: successful management with debridement and vacuum assisted closure,” European Journal of Cardio-thoracic Surgery, vol. 28, no. 4, pp. 645–647, 2005.
[17]
R. E. Hersh, A. K. Kaza, S. M. Long, S. M. Fiser, D. B. Drake, and C. G. Tribble, “A technique for the treatment of sternal infections using the Vacuum Assisted Closure device,” Heart Surgery Forum, vol. 4, no. 3, pp. 211–215, 2001.
[18]
T. Weed, C. Ratliff, D. B. Drake et al., “Quantifying bacterial bioburden during negative pressure wound therapy: does the wound VAC enhance bacterial clearance?” Annals of Plastic Surgery, vol. 52, no. 3, pp. 276–280, 2004.
[19]
M. L. Blum, M. Esser, M. Richardson, et al., “Negative pressure wound therapy reduces deep infection rate in open tibial fractures,” Journal of Orthopaedic Trauma, vol. 26, no. 9, pp. 499–505, 2012.
[20]
S. J. Lalliss, D. J. Stinner, S. M. Waterman, J. G. Branstetter, B. D. Masini, and J. C. Wenke, “Negative pressure wound therapy reduces pseudomonas wound contamination more than staphylococcus aureus,” Journal of Orthopaedic Trauma, vol. 24, no. 9, pp. 598–602, 2010.
[21]
E. A. Azzopardi, D. E. Boyce, W. A. Dickson, et al., “Application of topical negative pressure (vacuum-assisted closure) to split-thickness skin grafts: a structured evidence-based review,” Annals of Plastic Surgery, vol. 70, pp. 23–29, 2013.
[22]
L. A. Dainty, J. J. Bosco, J. W. McBroom, W. E. Winter III, G. S. Rose, and J. C. Elkas, “Novel techniques to improve split-thickness skin graft viability during vulvo-vaginal reconstruction,” Gynecologic Oncology, vol. 97, no. 3, pp. 949–952, 2005.
[23]
L. X. Webb, “New techniques in wound management: vacuum-assisted wound closure,” Journal of the American Academy of Orthopaedic Surgeons, vol. 10, no. 5, pp. 303–311, 2002.
[24]
S. U. Eisenhardt, Y. Schmidt, J. R. Thiele et al., “Negative pressure wound therapy reduces the ischaemia/reperfusion-associated inflammatory response in free muscle flaps,” Journal of Plastic, Reconstructive and Aesthetic Surgery, vol. 65, no. 5, pp. 640–649, 2012.
[25]
P. C. Bristow, K. L. Perry, Z. J. Halfacree, and V. J. Lipscomb, “Use of vacuum-assisted closure to maintain viability of a skin flap in a dog,” Journal of the American Veterinary Medical Association, vol. 243, pp. 863–868, 2013.
[26]
J. S. Bryden, K. A. Pitt, C. D. Weder, et al., “Effects of negative pressure wound therapy on healing of free full-thickness grafts in dogs,” Veterinary Surgery, vol. 42, pp. 511–552, 2013.
[27]
R. A. White, R. A. Miki, P. Kazmier, and J. O. Anglen, “Vacuum-assisted closure complicated by erosion and hemorrhage of the anterior tibial artery,” Journal of Orthopaedic Trauma, vol. 19, no. 1, pp. 56–59, 2005.
[28]
G. A. Jones, J. Butler, I. Lieberman, and R. Schlenk, “Negative-pressure wound therapy in the treatment of complex postoperative spinal wound infections: complications and lessons learned using vacuum-assisted closure,” Journal of Neurosurgery, vol. 6, no. 5, pp. 407–411, 2007.
[29]
U. Sartipy, U. Lockowandt, J. G？bel, L. Jidéus, and G. Dellgren, “Cardiac rupture during vacuum-assisted closure therapy,” Annals of Thoracic Surgery, vol. 82, no. 3, pp. 1110–1111, 2006.
[30]
W. Fleischmann, U. Becker, M. Mischoff, et al., “Vacuum sealing: indication, technique, and results,” European Journal of Orthopaedic Surgery and Traumatology, vol. 5, pp. 37–40, 1995.
[31]
M. J. Adkesson, E. K. Travis, M. A. Weber, J. P. Kirby, and R. E. Junge, “Vacuum-assisted closure for treatment of a deep shell abscess and osteomyelitis in a tortoise,” Journal of the American Veterinary Medical Association, vol. 231, no. 8, pp. 1249–1254, 2007.
[32]
P. E. Banwell and M. Musgrave, “Topical negative pressure therapy: mechanisms and indications,” International wound journal, vol. 1, no. 2, pp. 95–106, 2004.
