Management Of Chronic Wounds In Opiate Use Disorder Patients Using Pressurized Pulsed Irrigation
Patrick V. Marasco, MD,FACS1, Mary Anderson, MD,DO2.
1Plastic Surgery Center, North Andover, MA, USA, 2Baldpate Hospital, Georgetown, MA, USA.
Background: Substance use disorders (SUDs) are on the rise in the United States. Injection drug use (IDU) causes chronic wounds due to vein, muscle, subcutaneous injection site infections, adverse skin reactions (i.e. cocaine-levamasole), talc injection or overdose pressure injury. Methicillin-resistant Staphylococcus aureus (MRSA) frequently produces severe cellulitis, abscesses, necrotizing fasciitis resulting in non-healing wounds. Opiate use disorder (OUD) patients are at risk of non-healing due to mu receptor inhibition of keratinocytes resulting in higher pain levels, longer length of stay, higher re-admission rates and higher healthcare costs. Pressurized pulsed irrigation (PPI) is standard practice for contaminated, infected or traumatic wounds, to remove wound bacteria biofilm, necrotic tissue and debris. Closed Pulse Irrigation* (CPI*) is a system that provides frequent PPI hydromechanical debridement without cross-contamination, anesthetics, bleeding and high surgical cost. Purpose: We describe two OUD patients with multiple non-healing extremity wounds who received CPI* hydromechanical debridement as a new "antibiofilm" strategy to control wound bacterial burden and promote healing. Methods: Closed pressurized irrigation uses a hydromechanical irrigator (8 - 15 psi) to deliver 3 L NS at 90⁰ F within a safe, omnidirectional containment system to serially debride OUD wounds patients during opiate detoxification admission. Hydrogel dressings were applied. Results: Clinical results demonstrate that daily PPI was used to successfully promote healing in OUD patients while admitted for detoxificaton. An average of 20 daily closed pressurized irrigation treatments achieved complete healing with an improved quality of life and safe transition to home. Conclusions: Effective management of SUDs wound patients is critical. SUDs wound patients receiving PPI showed significant early improvement leading to successful healing by secondary intention.
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