Does NPWT improve the outcome of osteomyelitis in HCV-HIV coinfected patient?

Osteomyelitis with severe skin and soft tissue damage in critically ill patients cannot be treated solely by an orthopaedic specialist. In such patients, a team approach is required. We report the treatment of osteomyelitis in a HCV and HIV positive patient with several severe comorbidities (liver failure, peripheral vascular disease and peripheral neuropathy). The patient underwent mechanical debridement, followed by a three months of antibiotic therapy. Six months later the infection relapsed and a second debridement was performed. V.A.C.Ulta therapy with instillation of “Dermacyn” solution, a super-oxidized disinfectant, as antiseptic solution was applied for 20 days and the wound healed. Three-years follow-up with inflammatory laboratory tests, clinical and radiographic examinations showed healing of the wound without any relapse of infection. In this paper, we suggest combining debridement and NPWT with instillation for critical patients with severe soft tissue damage that poorly respond to other therapies. Keywords—antibiotic therapy, HCV, HIV, osteomyelitis, Negative Pressure Wound Therapy, instillation