Injectable Vancomycin Contained Within a Hyaluronic Acid-Impregnated Alginate Carrier: A Novel Technique for Prophylaxis Against Surgical Site Infection

Topical vancomycin powder is used intraoperatively to mitigate the risk of surgical site infection. The method is purported to create supraphysiologic levels of the antibiotic locally, preventing biofilm formation and bacterial colonization, with only a transient effect systemically. However, the concentration and duration of the effect of antibiotics locally remains unclear; concern(s) regarding potential effects on mesenchymal stem cell osteogenic differentiation have been raised and postoperative maceration is not uncommon. The combination of vancomycin with an impregnated carrier processing a gradual dissolution profile over time could theoretically improve efficacy by minimizing any sudden "high concentration burst" and reducing postoperative drainage while prolonging the physiologic levels locally. The purpose of the present article is to describe the author's novel techniques for injectable vancomycin powder contained within a hyaluronic acid-impregnated alginate carrier for prophylaxis against surgical site infection.