Smoldering subcutaneous polymicrobial infection concealed beneath a cast and a skin graft: Delayed wound healing due to recurring soft-tissue infections

Abstract

Injury to soft-tissues secondary to trauma is common and may require surgical intervention depending on the extent of the injury and the structures involved. Motor vehicle accidents are a leading cause of traumatic injury and often require surgical irrigation and debridement (I&D) to remove damaged and necrotic tissue while preserving tissue integrity and function. Surgical intervention carries its own risks, however, with the introduction of pathogens to the surgical site being a potential complication. This case of an 18 yr. old woman with a chronic would due to recurring skin and soft tissue infections (SSTIs) highlights the complications of surgical intervention and the difficulty of dealing with recurring SSTIs. The patient suffered a left knee injury with patellar tendon laceration secondary to trauma from a motor vehicle accident. She initially underwent surgical irrigation and debridement, followed by patellar tendon repair with a rotational flap to close the open wound. Following the initial closure in December 2019, the patient underwent 6 more I&Ds and wound debridement over a 5-month period due to a chronic non-healing wound with recurring SSTIs.  Wound Healing was tentatively achieved with antibiotic coverage for both Staph Aureus and Pseudomonas Aeruginosa.