Mylène Jansen

Reduction of pin tract infections during KJD 159 8 Cadexomer iodine (Iodosorb®, Smith & Nephew) Since March 2019, patients treated with KJD receive antimicrobial ointment to use on pin tracts during the distraction period. Iodosorb® (Smith & Nephew, Watford, United Kingdom) ointment consists of small cadexomer (polysaccharide) beads containing 0.9% iodine that can absorb wound exudate, pus and debris. 16,17 The absorption causes the beads to swell, allowing a sustained release of iodine. As more iodine is released, the color gradually changes from brown to white/gray, indicating the ointment is no longer effective and wound care should be performed. Wound care protocol Except for the use of Iodosorb®, the advised wound care protocol was identical for all patients. Patients were instructed to perform the following wound care every 1 to 3 days: first, the distraction frame is cleaned using non-sterile water (for example in the shower) and the gauze around all pins is removed. If the patient used Iodosorb®, the old ointment is removed from the wounds. The skin around the pins is massaged, freeing it from the pin and causing any accumulation of exudate to surface. After, the pins are cleaned using 70% alcohol, moving from the skin upwards. The skin around the pins is cleaned by dabbing it with chlorhexidine 0.5% (in alcohol 70%), using clean gauze. If the patient is using Iodosorb®, fresh ointment is subsequently reapplied to the wounds; if the wounds are clean and dry, application is not needed. Finally, clean gauze is applied around the pins and fixed with plasters. After removal of the KneeReviver, Iodosorb® was not applied anymore. Statistical analyses Patients who used Iodosorb® during their KJD treatment (March 2019–December 2019) were compared with patients who did not use Iodosorb® during treatment (November 2017–March 2019). Baseline age, sex, BMI, diabetes mellitus, smoking status and treated leg (left/right) were compared between the 2 groups using independent 2-tailed t -tests for continuous variables and chi-square tests for nominal variables. Diabetes mellitus and smoking status were included because they, like age and sex, are known risk factors for infections during fixation. 18,19 All data was extracted from patients’ electronic records; no missing data was expected since all data was required before treatment could be performed. Outcome parameters were the number of patients requiring antibiotics for pin tract infections, the number of patients requiring more than 1 standard 7-day oral antibiotic course (indicating a more serious infection), and the number of patients with infections after frame removal. All 3 outcome parameters were compared between groups using chi-square tests. P- values <0.05 were considered statistically significant. IBM SPSS Statistics version 25 (IBM Corp; Armonk, NY) was used for all statistical analyses.