Use of Bioactive Glass on Infected, Exposed Hardware.

Introduction: A dreaded complication of implanting surgical hardware with a wound dehiscence with exposed hardware. Literature regarding biofilms illustrates the difficult of successfully treating biofilm. Biofilm is difficult to eradicate and reforms quite rapidly after surgical debridement. How can we expedite healing in a chronic wound secondary to dehiscence with exposed hardware. What are our novel choics that we can make, utilizing new technology.Methods:The post-surgical dehisced wounds were surgically debrided as a treatment for assumed biofilm on the exposed hardware. Due to the persistent and recalcitrant nature of biofilm, bioactive glass was applied to the exposed hardware. The bioactive glass was applied to prevent the biofilm from causing delayed or non-healing. The bioactive glass was then overlaid with a dermal scaffold.Results:In the case of presumptive biofilm on exposed hardware, newer technologies should be considered to prevent the typical complications from exposed hardware. The two case studies demonstrated robust, viable formation of dermal tissue, following the application of bioactive glass that was overlaid with an engineered dermal filler.Discussion: In the event of wound dehiscence with exposed hardware, the clinician should be aware of the risk of delayed healing, prolonged infection and failure of delayed primary closure. Consideration of newer technologies, such as bioactive glass, should be considered at as important adjunct to prevent the aforementioned complications. Although we have many commercially available dermal scaffolds, that are not engineered to be antibacterial. Local antimicrobial treatments should be considered. Oral and intravenous antibiotics are not always successful at treating biofilms, due to the structure of the biofilm. A biofilm is a complex structure that is strengthened by the extra-polymeric substance encasing it and metallic bonds. Clinically, the outcome are worse for a wound dehiscence, the older the becomes. Time is of the essence to heal these chronic wounds, secondary to dehiscence, as prolonged healing time correlates with the need for further surgeries, possible hospitalizations and worsening economy for patients.  References:Archer NK, Mazaitis MJ, Costerton JW, Leid JG,Staphylococcus aureus biofilms: Properties, regulation, and roles in human disease. Virulence, 2011 Sep 1;2(5):445- 59. Epub 2011 Sep 1 Armstrong, David G., et al. “A multi‐centre, single‐blinded randomised controlled clinical trial evaluating the effect of resorbable glass fibre matrix in the treatment of diabetic foot ulcers.” International Wound Journal, vol. 19, no. 4, 2021, pp. 791 801 Buck, Donald W. “Innovative bioactive glass fiber technology accelerates wound healing and minimizes costs: A case series.” Advances in Skin & Wound Care, vol. 33, no. 8, 2020, pp. 1–6 De Giglio, Roberto, et al. “Efficacy and safety of bioactive glass S53P4 as a treatment for diabetic foot osteomyelitis.” The Journal of Foot and Ankle Surgery, vol. 60, no. 2, 2021, pp. 292–296, https://doi.org/10.1053/j.jfas.2020.06.029. Gristina AG, Naylor PT, Myrvik QN: Mechanisms of Musculoskeletal Sepsis. Orthop Clin North Am, 1991 ;22:363-371 Malat, Tarek Al, et al. “The use of bioactive glass S53P4 as bone graft substitute in the treatment of chronic osteomyelitis and infected non-unions – a retrospective study of 50 patients.” Zeitschrift Für Orthopädie Und Unfallchirurgie, vol. 156, no. 02, 2018, pp. 152–159