Xuan Luo, MD, FAAOS | Peter Joo, MD, MPH | Ebunoluwa Olawole, MD

Infections in the upper extremity can cause significant morbidity and management of these infections can often cause significant burdens on the healthcare system. Infections related to the upper extremity may be caused by direct inoculation of the soft tissues, bone, or joint, and the complex anatomy of the upper extremity may pose challenges in management for hand surgeons. The use of Negative Pressure Wound Therapy (NPWT) in management of upper extremity infections has significantly broadened the armamentarium of coverage options for hand surgeons, allowing for incisional NPWT, more time for tissue granulation, and opening up options for staged reconstructions.

Further, closed suction surgical drains have been used for surgical management of infections as a way to prevent postoperative seromas and hematomas and theoretically reduce risk of wound dehiscence, complications, and recurrent infection. While some have described use of both closed-suction surgical drains and NPWT, using both on the same wound can cause vacuum leaks through the drain tracks, causing frequent leak alarms and reducing the efficacy of the negative pressure therapy.

Therefore, this video describes a novel technique that incorporates closed-suction surgical drains directly into the incisional NPWT dressing to create a sterile, closed-system environment in management of upper extremity infections. This combines the benefit of deeper surgical drains with the NPWT wound vacuum-assisted closure (VAC) system, creating a sterile environment without external drain tracks that could prevent closure of the dead space, and decrease burden of patient care during recovery with only one external line to manage.