Atypical wounds. Best clinical practice and challenges

Clinically inactive pyoderma gangrenosum successfully treated with negative pressure therapy and punch grafting

“…However, once inflammation is controlled by systemic immunosuppresion, these wounds may benefit from invasive treatments. [3][4][5] We present a case of pyoderma gangrenosum under immunosuppression, with no clinical signs of inflammation that responded successfully to negative pressure therapy and punch grafting.…”

“…Once the inflammatory activity is controlled, the strategy to facilitate the formation of granulation tissue and promote epithelialization will be similar to that used in wounds of other aetiologies. 5 Therefore, negative pressure therapy and thin split-thickness grafts will be good alternatives, either alone or in combination, to accelerate healing. [3][4][5] Punch grafting is a traditional and minimal invasive technique to enhance wound healing, which may be performed in an outpatient basis.…”

“…5 Therefore, negative pressure therapy and thin split-thickness grafts will be good alternatives, either alone or in combination, to accelerate healing. [3][4][5] Punch grafting is a traditional and minimal invasive technique to enhance wound healing, which may be performed in an outpatient basis. These thin split-thickness skin grafts, which contain epidermis and papillary dermis, are obtained under local anaesthesia with a punch, curette, or surgical blade and are placed directly on the wound bed.…”

“…Local pressure and immobilisation during the first 3 to 4 days after the procedure are essential for graft taking. 5 When grafting a wound bed with optimal granulation tissue, as in this case, a 100% graft uptake may be obtained. However, if the wound bed conditions are not perfect and grafts do not adhere, the procedure is still useful as grafts will release growth factors and cells that promote epithelialization and reduce pain.…”

“…However, if the wound bed conditions are not perfect and grafts do not adhere, the procedure is still useful as grafts will release growth factors and cells that promote epithelialization and reduce pain. 5 The combined use of negative pressure therapy and punch grafting has several advantages considering graft taking. On the one hand, their sequential use is of great interest, as the application of negative pressure promotes the formation of granulation tissue, with reduction of exudate and bacterial load, and therefore prepares the wound bed to facilitate graft taking.…”