Antibiotic-Loaded Bone Cement-Induced Membrane and Skin Grafting in Elderly Patients with Refractory Lower Limb Wounds

Refractory lower limb wounds in the elderly population represent a significant and growing clinical challenge, often complicated by factors such as chronic infection, poor tissue vascularization, and multiple comorbidities. These wounds frequently lead to prolonged healing times, increased healthcare costs, and diminished quality of life for affected patients. This protocol article describes a detailed two-stage surgical technique that utilizes antibiotic-loaded polymethyl methacrylate (PMMA) bone cement to induce a vascularized membrane, followed by secondary skin grafting. The procedure is systematically outlined, beginning with patient selection criteria and progressing through radical wound debridement, intraoperative preparation and implantation of the vancomycin-loaded cement spacer, postoperative care, and subsequent spacer removal with application of a split-thickness skin graft onto the newly formed induced membrane. We provide a direct comparative framework against the conventional vacuum sealing drainage (VSD) technique. In this retrospective cohort study, representative results demonstrate that this method contributes to local infection control, as both groups showed a reduction in culture positivity postoperatively. Furthermore, it promotes a more robust angiogenic response within the induced membrane. Although the final wound healing rate at 70 days was comparable between groups, the PMMA method demonstrated a significantly shorter time to complete healing compared to VSD. The protocol also presents potential benefits in reducing the overall economic and psychological burden on patients. This comprehensive guide enables the replication of a promising surgical strategy for managing complex lower limb wounds in elderly patients.