Barn yard polymicrobial bacterial contamination of complex lower extremity wound successfully healed with Chlorhexidine Gluconate (CHG) irrigation and wound debridements

Introduction: A case report was compiled for a 66 y.o. male with past medical history of factor V Leyden mutation, essential hypertension, chronic lymphedema, obesity, DVT of the lower extremity, diabetic ulcer of the left midfoot, severe calcific aortic valve stenosis, diabetes mellitus type 2, history of osteomyelitis requiring partial fifth ray amputation, history of pulmonary embolism. In this case report, surgical intervention and various advanced wound methods were utilized when a very high risk of proximal amputation was present.Methods:Case report includes a male patient with diabetes, neuropathy, prior partial amputation of left fifth ray secondary to osteomyelitis that subsequently developed dehiscence. The patient continued to work outside on the farm and developed heavy contamination without advanced signs of infection, with wound cultures growing multiple bacteria with resistance. After wound debridement, a jet lavage containing low concentration chlorhexidine gluconate (CHG) 0.05% in sterile water was used for irrigation in the office setting. This mechanical action helped remove bacteria and other particulates without harming the surrounding tissue.Results:The patient grew out an array of bacteria from the wound including Proteus, Bateroides fragilis, Citrobacter Koseri, Morganella, Klebsiella, Enterobacter, Pseudomonas, E. Coli, and Serratia. The patient was an uncontrolled diabetic that continued to work on his farm, regularly presenting to clinic with his dressings wet and muddy, and at one point presenting with maggots. the patient underwent weekly debridements with irrigation of Chlorhexidine gluconate, which can prevent bacterial growth for at least 48 hours. The patient was able to heal his wound within 12 weeks and has remained healed at this time.Discussion: A combination of surgical intervention, serial debridements, and irrigation with CHG allowed a medically complex and non compliant patient to heal his wounds with his continued high levels of activity and potential exposure to bacteria and other contaminants. This case report exemplifies some of the additional modalities that can be considered for successful long term limb salvage in complex cases.References: