[141729314]
A patient reported having experienced two large blisters a few days post-op total knee arthroplasty under the adhesive border of the dressing used to cover the incision. One of the blisters broke open and is believed to be an entry point for infection. Although likely limited to cellulitis, it was treated as a deep wound infection, resulting in a secondary surgery to reopen wound, irrigate, debride and replace the polyethylene tibial component of the knee prosthesis, followed by an ongoing six months of iv and oral antibiotic therapy. Follow up information received from the patient reported previous history of blistering when using steri-strips and unspecified reactions to adhesive. The wound has since healed. The patient stated the infectious disease doctor presumed the entry site of the infection was due to a serous blister. Follow up information received from the surgeon indicates the patient was advised to follow up with the doctor after the first surgery, but did not. She began physical therapy as prescribed and reported redness around the periwound and formation of a blister to the physical therapist, who advised the patient to go to emergency room due to potential infection. A review of the patient's medical records indicates initial surgery was performed with no apparent intra-operative complications and a mepilex dressing was placed. The patient presented at the er 1 week status post op a left tka with erythema and warmth to her knee that has been getting worse over previous 3 days. No wound drainage, no fever or chills. Certain superficial cellulitis, with possible deep infection. Revision surgery performed by same surgeon with no apparent intra-operative complications. Ancef 2 grams q8hrs per infectious disease, follow culture results. Pico skin vac placed x 1 week, then replace with regular mepilex dressing.
Patient Sequence No: 1, Text Type: D, B5