Background: There are inherent challenges in the management of aquatic injuries due to a number of difficult-to-anticipate sequelae. Propeller injuries significantly complicate management via significant contamination, delayed ischemia, and exposure to unusual water-associated organisms. The purpose of this case study is to present a unique circumstance where source control was achieved in a patient who suffered from an Aeromonas hydrophilus necrotizing infection after traumatic aquatic amputation.
Case: The patient was a 26-year-old female who sustained a propeller injury in a notable brackish water lake. She was swimming to the edge of the boat when the propeller was engaged, causing her right lower extremity to be sucked into the blade and subsequently collide with the cavitation place. This resulted in multiple significant linear lacerations and avulsions, as well as a Gustilo IIIB fracture. Due to the extent of damage upon presentation, the patient was rushed to the OR for a transfemoral amputation. Serial washouts began early in the hospital course but the patient did not hemodynamically tolerate debridement well. Tissue cultures showed Aeromonas hydrophilus infection. At this time, it was decided to attempt achievement of source control through use of negative pressure wound therapy with instillation of 0.25% sodium hypochlorite solution. Within two days of NPWT-i initiation, lab values normalized and patient began to clinically improve. NPWT-i was continued throughout the hospitalization until grafting was able to be performed. On hospital day 51, nearly 100% take of split-thickness grafting was noted with no residual tissue loss. At 167 days after initial injury, the patient took her first steps on her prosthetic limb.
Conclusion: The usage of NPWT-i gives clinicians the option to achieve source control in complex wounds with active, myonecrotic infection through bactericidal solution instillation.