Application of plasma-mediated bipolar radiofrequency ablation debridement in treatment with retention of internal fixation for early postoperative infection of fractures of extremities_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LU Yao ^1,2 ,  YANG Rungong ^1,2 , ZHU Jialiang ² , YANG Lin ² , BAI Yuzhe ² , SE Rigeleng ² , YING Yaoqi ²

1. Chinese PLA Medical School, Beijing, 100853, P.R.China;
2. Department of Orthopaedics, Extremities Repair and Reconstructive Surgery, First Affiliated Hospital of PLA General Hospital, Beijing, 100048, P.R.China;

Corresponding author：

YANG Rungong, Email: 13911598119@139.com

Keywords：

Plasma-mediated bipolar radiofrequency ablation; debridement; fracture; postoperative infection; internal fixation

DOI：

10.7507/1002-1892.201706066

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Objective To explore the effectiveness of plasma-mediated bipolar radiofrequency ablation debridement (Coblation debridement) in treatment with retention of internal fixation for early postoperative infection of fractures of extremities. Methods Between January 2012 and May 2015, 16 patients (12 males and 4 females) with early postoperative infection of internal fixation for extremity fracture were treated, with an average age of 41.6 years (range, 19-61 years). The fractures included tibia and fibula fracture in 5 cases, femoral fractures in 5 cases, distal humeral fractures in 3 cases, ulna and radius fractures in 2 cases, and patellar fracture in 1 case. Two cases were open fractures and 14 cases were closed fractures. All fractures were fixed non-intramedullarily. Postoperative infection occurred at 5-10 days (mean, 7 days) after operation, with bacteria cultured from wound secretion in all cases. Type EIC5872 70 Coblation knife and Coblator Ⅱ plasma surgery system were conducted to debride the foci of infection in ablating pattern with sterile saline used as the conductive fluid and the magnitude of power from 6 to 9. After pulse irrigating with sterile saline, irrigating tube and draining tube were placed beside the fixation. Postoperative continuous irrigation and drainage and systemic antibiotic therapy would be conducted. The effectiveness was evaluated by bone infection effectiveness evaluation criteria. Results All the 16 patients were followed up 12-36 months (mean, 15 months) after operation. All the infected wounds were cured and healed by first intention without recurrence in all the patients, and the fracture healing time was 3-7 months (mean, 4.8 months) without limb dysfunction or nonunion. Internal fixation was removed at 1-2 years after operation in 4 cases, whom with good fracture healing and without recurrence of infection after operation. Conclusion The effectiveness of Coblation debridement in treatment with retention of internal fixation for early postoperative infection of extremity fractures are satisfactory, which can avoid the second stage operation, infectious nonunion, and osteomyelitis.

Citation： LU Yao, YANG Rungong, ZHU Jialiang, YANG Lin, BAI Yuzhe, SE Rigeleng, YING Yaoqi. Application of plasma-mediated bipolar radiofrequency ablation debridement in treatment with retention of internal fixation for early postoperative infection of fractures of extremities. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(11): 1281-1286. doi: 10.7507/1002-1892.201706066 Copy

1.	Pavoni GL, Giannella M, Falcone M, et al. Conservative medical therapy of prosthetic joint infections: retrospective analysis of an 8-year experience. Clin Microbiol Infect, 2004, 10(9): 831-837.
2.	王自友, 万红娟, 张家启, 等. 改良式经髓腔内置管闭式持续灌洗引流治疗胫骨慢性骨髓炎. 中国骨与关节损伤杂志, 2015, 30(6): 50-51.
3.	Trampuz A, Zimmerli W. Diagnosis and treatment of infections associated with fracture-fixation devices. Injury, 2006, 37 Suppl 2: S59-S66.
4.	Berkes M, Obremskey WT, Scannell B, et al. Maintenance of hardware after early postoperative infection following fracture internal fixation. J Bone Joint Surg (Am), 2010, 92(4): 823-828.
5.	Hurlow J, Bowler PG. Potential implications of biofilm in chronic wounds: a case series. J Wound Care, 2012, 21(3): 109-110, 112, 114.
6.	Wolcott RD, Cox S. More effective cell-based therapy through biofilm suppression. J Wound Care, 2013, 22(1): 26-31.
7.	Percival SL, Hill KE, Williams DW, et al. A review of the scientific evidence for biofilms in wounds. Wound Repair Regen, 2012, 20(5): 647-657.
8.	Daeschlein G, Lehnert W, Arnold A, et al. Hygienic safety of a new hydrodynamic wound debridement system. Dermatol Surg, 2010, 36(9): 1426-1438.
9.	Chen MJ, Yang C, Zhang SY, et al. Use of Coblation in arthroscopic surgery of the temporomandibular joint. J Oral Maxillofac Surg, 2010, 68(9): 2085-2091.
10.	Paramasivan VK, Arumugam SV, Kameswaran M. Randomised comparative study of adenotonsillectomy by conventional and coblation method for children with obstructive sleep apnoea. Int J Pediatr Otorhinolaryngol, 2012, 76(6): 816-821.
11.	Zhu H, Zhou XZ, Cheng MH, et al. The efficacy of coblation nucleoplasty for protrusion of lumbar intervertebral disc at a two-year follow-up. Int Orthop, 2011, 35(11): 1677-1682.
12.	Jakanani GC, Jaiveer S, Ashford R, et al. Computed tomography-guided coblation and cementoplasty of a painful acetabular metastasis: an effective palliative treatment. J Palliat Med, 2010, 13(1): 83-85.
13.	Kramer A, Hübner NO, Weltmann KD, et al. Polypragmasia in the therapy of infected wounds-conclusions drawn from the perspectives of low temperature plasma technology for plasma wound therapy. GMS Krankenhhyg Interdiszip, 2008, 3(1): Doc13.
14.	Yang R, Zuo T, Zhu J, et al. Effect of radiofrequency ablation on healing of infected full-thickness wounds in minipigs. Int J Low Extrem Wounds, 2013, 12(4): 265-270.
15.	Nusbaum AG, Gil J, Rippy MK, et al. Effective method to remove wound bacteria: comparison of various debridement modalities in an in vivo porcine model. J Surg Res, 2012, 176(2): 701-707.
16.	Sonnergren HH, Polesie S, Strömbeck L, et al. Bacteria aerosol spread and wound bacteria reduction with different methods for wound debridement in an animal model. Acta Derm Venereol, 2015, 95(3): 272-277.
17.	Trial C, Brancati A, Marnet O, et al. Coblation technology for surgical wound debridement: principle, experimental data, and technical data. Int J Low Extrem Wounds, 2012, 11(4): 286-292.
18.	Bowler PG. The 10(5) bacterial growth guideline: reassessing its clinical relevance in wound healing. Ostomy Wound Manage, 2003, 49(1): 44-53.
19.	中华医学会创伤学分会创伤急救与多发伤学组、创伤感染学组、组织修复学组. 创面局部用药防治感染规范. 中华创伤杂志, 2013, 29(10): 905-907.
20.	Kim JI, Suh KT, Kim SJ, et al. Implant removal for the management of infection after instrumented spinal fusion. J Spinal Disord Tech, 2010, 23(4): 258-265.
21.	Chen SH, Lee CH, Huang KC, et al. Postoperative wound infection after posterior spinal instrumentation: analysis of long-term treatment outcomes. Eur Spine J, 2015, 24(3): 561-570.

1. Pavoni GL, Giannella M, Falcone M, et al. Conservative medical therapy of prosthetic joint infections: retrospective analysis of an 8-year experience. Clin Microbiol Infect, 2004, 10(9): 831-837.
2. 王自友, 万红娟, 张家启, 等. 改良式经髓腔内置管闭式持续灌洗引流治疗胫骨慢性骨髓炎. 中国骨与关节损伤杂志, 2015, 30(6): 50-51.
3. Trampuz A, Zimmerli W. Diagnosis and treatment of infections associated with fracture-fixation devices. Injury, 2006, 37 Suppl 2: S59-S66.
4. Berkes M, Obremskey WT, Scannell B, et al. Maintenance of hardware after early postoperative infection following fracture internal fixation. J Bone Joint Surg (Am), 2010, 92(4): 823-828.
5. Hurlow J, Bowler PG. Potential implications of biofilm in chronic wounds: a case series. J Wound Care, 2012, 21(3): 109-110, 112, 114.
6. Wolcott RD, Cox S. More effective cell-based therapy through biofilm suppression. J Wound Care, 2013, 22(1): 26-31.
7. Percival SL, Hill KE, Williams DW, et al. A review of the scientific evidence for biofilms in wounds. Wound Repair Regen, 2012, 20(5): 647-657.
8. Daeschlein G, Lehnert W, Arnold A, et al. Hygienic safety of a new hydrodynamic wound debridement system. Dermatol Surg, 2010, 36(9): 1426-1438.
9. Chen MJ, Yang C, Zhang SY, et al. Use of Coblation in arthroscopic surgery of the temporomandibular joint. J Oral Maxillofac Surg, 2010, 68(9): 2085-2091.
10. Paramasivan VK, Arumugam SV, Kameswaran M. Randomised comparative study of adenotonsillectomy by conventional and coblation method for children with obstructive sleep apnoea. Int J Pediatr Otorhinolaryngol, 2012, 76(6): 816-821.
11. Zhu H, Zhou XZ, Cheng MH, et al. The efficacy of coblation nucleoplasty for protrusion of lumbar intervertebral disc at a two-year follow-up. Int Orthop, 2011, 35(11): 1677-1682.
12. Jakanani GC, Jaiveer S, Ashford R, et al. Computed tomography-guided coblation and cementoplasty of a painful acetabular metastasis: an effective palliative treatment. J Palliat Med, 2010, 13(1): 83-85.
13. Kramer A, Hübner NO, Weltmann KD, et al. Polypragmasia in the therapy of infected wounds-conclusions drawn from the perspectives of low temperature plasma technology for plasma wound therapy. GMS Krankenhhyg Interdiszip, 2008, 3(1): Doc13.
14. Yang R, Zuo T, Zhu J, et al. Effect of radiofrequency ablation on healing of infected full-thickness wounds in minipigs. Int J Low Extrem Wounds, 2013, 12(4): 265-270.
15. Nusbaum AG, Gil J, Rippy MK, et al. Effective method to remove wound bacteria: comparison of various debridement modalities in an in vivo porcine model. J Surg Res, 2012, 176(2): 701-707.
16. Sonnergren HH, Polesie S, Strömbeck L, et al. Bacteria aerosol spread and wound bacteria reduction with different methods for wound debridement in an animal model. Acta Derm Venereol, 2015, 95(3): 272-277.
17. Trial C, Brancati A, Marnet O, et al. Coblation technology for surgical wound debridement: principle, experimental data, and technical data. Int J Low Extrem Wounds, 2012, 11(4): 286-292.
18. Bowler PG. The 10(5) bacterial growth guideline: reassessing its clinical relevance in wound healing. Ostomy Wound Manage, 2003, 49(1): 44-53.
19. 中华医学会创伤学分会创伤急救与多发伤学组、创伤感染学组、组织修复学组. 创面局部用药防治感染规范. 中华创伤杂志, 2013, 29(10): 905-907.
20. Kim JI, Suh KT, Kim SJ, et al. Implant removal for the management of infection after instrumented spinal fusion. J Spinal Disord Tech, 2010, 23(4): 258-265.
21. Chen SH, Lee CH, Huang KC, et al. Postoperative wound infection after posterior spinal instrumentation: analysis of long-term treatment outcomes. Eur Spine J, 2015, 24(3): 561-570.

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Application of plasma-mediated bipolar radiofrequency ablation debridement in treatment with retention of internal fixation for early postoperative infection of fractures of extremities

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