Salvage of an Infected Below-Knee Amputation with Chlorhexidine and Bi-Layer Dermal Matrix: A Case Report

Abstract

Background: Salvage of below-knee amputations is of utmost importance as studies have shown dramatically improved ambulation rates and overall outcomes. Multiple techniques of BKA stump preservation have been described in the literature, from conservative management to free tissue transfer, each with differing success and complication rates. Method: We present a staged treatment of a grossly infected BKA stump with minimal soft tissue coverage using aggressive debridement, intravenous antibiotics, chlorhexidine immersion, and staged bi-layer dermal matrix placement with interval split thickness skin grafting. Results: The patient is now twelve-months out from surgery and ambulating on a below-knee prosthetic limb without the need to replace the prosthetic limb. Conclusion: The adoption of chlorhexidine irrigation to the clinical algorithm has greatly aided in eradication of infection, dermal matrix engraftment and salvage of lower extremity wounds.