Treatment for Chronic Contaminated Wound After Total Thyroidectomy

Thea Price, MD
Rush University Medical Center, Chicago, IL

Patient Presentation

A 59-year-old woman presented in May 2018 with delayed tracheal injury and perforation with abscess after total thyroidectomy for cancer. She returned to the OR for drainage and muscle flap complicated by dehisced surgical site infection. Comorbidities included: papillary thyroid adenocarcinoma

Failed Therapy

  • Failed surgical repair with muscle flap

Procedure & Treatment

  • Tracheal perforation closed with muscle flap
  • Cultures: Group A Streptococcus Pyogenes
  • Initial Thyroidectomy 5/21/2018
  • Debridement and muscle flap 5/29/2018
  • Microlyte® applied at weekly evaluations
  • Non-excisional debridement during weekly evaluations
  • Secondary dressing with PICO vacuum
  • No additional dressing changes at home
  • No oral or topical antibiotics were administered

Clinical Outcome

By the first follow-up at Day 7, the wound had closed by ~90% based on wound volume (Figure 1B). Nine days later, the wound had closed by 98% (Figure 1C) and Microlyte® was applied. At the 4-week follow-up, the wound was fully closed. The wound remained healed and patient retains only a small scar in the site of the original wound.

Conclusion

Faster and more complete closure of a chronically infected wound was achieved by application of Microlyte® than was achievable with other failed therapies. This patient had multiple risk factors for postoperative surgical site infection including poor glycemic control, polymicrobial infection, and ongoing tobacco abuse. Microlyte® applied weekly was associated with a positive outcome and this patient was able to resume a normal lifestyle, including attending her own wedding without the need for a bandage on her neck.

Figure 1: Accelerated wound healing in infected, malignant, and radiated chronic plateaued wound after total thyroidectomy. Microlyte® was applied to wound 9 days post-surgery (A). After one week (B), the wound had closed by 90% (volume). Nine days later Microlyte® was applied again, at which point the wound was 98% closed (C). Complete wound closure was achieved with 28 days (D). Four months post operatively, only a small amount of scarring was visible (E). Microlyte® was reapplied at each evaluation. All secondary dressings were standard per clinician preference and wound characteristics.