The Efficacy of a Synthetic Bioresorbable Antimicrobial Matrix as an Implantable Material for At-Risk Surgical Wounds

Background: Surgery performed on diabetics is not without complication as increased serum glucose levels, neuropathy, and presence of an open wound potentiate post-operative infection risk. Implantation of a resorbable antimicrobial matrix aimed at reducing infection risk would prove a valuable addition to treatment protocol with surgery in the high-risk diabetic population. Diabetic patients undergoing non-emergent or elective surgery and recognized as at-risk were included in the study.  Patients identified as at-risk had one or more of the following: neuropathy, infection (treated), open wound, history of recurrent infection, nonhealing wound, or peripheral vascular disease (treated). Patients were educated on potential risks, benefits and complications of implanting the bioabsorbable silver containing matrix.  

Methods: Once informed consent was obtained, patients underwent a foot or ankle surgical procedure specific to their pathology.  After meticulous hemostasis and subcutaneous closure if applicable, the bioabsorbable antimicrobial matrix was implanted just deep to incision and the incision primarily closed.  Nonadherent cover dressing was applied and patient was scheduled for 3-5 day routine follow up.

Results: Signs of infection at the first post-operative appointment (between 3-5 days) were absent in all 20 patients and all patients went on to heal. 18 of the 20 healed at typical rate specific for the respective procedure. Two patients that took longer to heal did so secondary to weightbearing dehiscence. 100% of patients had diabetic peripheral neuropathy, 73% had open wounds and 67% had treated infection at time of surgery.  For all patients, the first post-op appointment showed no post-op infection or other complication.  Eighteen patients healed uneventfully.  Only 2 patients experienced weight-bearing dehiscence with wounds resolving after revisional surgery, use of the matrix and appropriate wound care. 

Conclusions: Application of the synthetic bioabsorbable antimicrobial matrix prior to primary closure is efficacious in prevention of post-operative infection in this high-risk diabetic population.