’It provides irrigation and an antimicrobial effect. Using PREVENTIA Surgical Irrigation means we have a better effect against potential infections. The two substances in PREVENTIA Surgical Irrigation – an agent against microbes and a surfactant – together prevent the formation of biofilms, and also deliver a strong antimicrobial effect.‘ The substance is more tissue-friendly than povidone-Iodine (PVP-I), also known as iodopovidone, which is commonly used as an antiseptic for skin disinfection before and after surgery and works faster than either 0.04% PHMB on its own or hypochlorous acid (HOCI). Tests have shown that it can reduce planktonic bacteria levels by 99.99% in just one minute, and disrupted biofilm effectively. Post-op problems Taking into account the many complicating factors with the initial surgery, the procedure was at first highly successful and the wound was clinically unremarkable with good mobility of the patient and the range of motion was highly satisfactory. Consequently, the patient was discharged after one week. In the rehabilitation phase the patient experienced a sudden ‘cracking’ in the knee joint, followed by a short period of pain that soon subsided. Later, there was suture dehiscence – a separation of previously approximated wound edges due to a failure of proper wound healing – following the removal of the staples that had been used to close the wound. Furthermore, a 1.5cm fistula presented, as well as redness around the wound. Poor healing is frequently observed in patients with diabetes mellitus, even if long-term glucose levels are well-maintained, so the outcome of this operation was not entirely unforeseen. On returning to the clinic on day 21 after surgery, there was extensive redness on the wound area and the wound had become purulent. She was taken back to revision surgery. ’We did the debridement and implant retention procedure (DAIR) according to the guidelines to treat an early onset infection, and changed during revision surgery the mobile components of the knee (the polyethylene) to reduce potential biofilm wearing components,’ explains Helwig. ’For the DAIR procedure Preventia was available and we used it for each revision surgery we performed on day 21 and on day 27. We did not know what germs would be inside the wound so we initially waited for five minutes to ensure that the broad antimicrobial effect of the irrigation had addressed any enterococci that might be present. If we leave PREVENTIA® Surgical Irrigation in the joint for a short time there are additional effects that we might not get if we were using other substances,’ he adds. In the cultures there was a Staphylococcus aureus found in the wound and the periprothetic tissue. In addition to the surgery, she was administered Flucloxacillin IV for 14 days combined with Rifampicine after second revision surgery and healed wounds. With no wound inflammation signs and laboratory without any pathological findings, she was discharged from hospital with oral Cotrimoxazol and Rifampicin for an additional 6 weeks. The patient was seen monthly for three months in the outpatient clinic without any pathological findings, and she was very satisfied with the result. ’There are always different goals for patient outcomes,’ says Helwig. ’At first, it was pain reduction and mobility with a prosthesis, but when you have an infection, the infection-free implant becomes the goal. Then you want to ensure good function. We are happy the implant is still in place and that the infection has not recurred.’ Infection-free and with a new lease of life, thanks to PREVENTIA® Surgical Irrigation and a skilled clinical team, meant that a very challenging case reached a successful conclusion. PRACTICE 27
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