Rare complication after VAC-therapy in the treatment of deep sore ulcers in a paraplegic patient

Abstract

The VAC-therapy is a safe, easy, and effective therapy for the management of chronic wounds. Known advantages of the VAC technique are the quicker wound healing by stimulating the blood flow, the formation of granulation tissue, angiogenesis, and cell proliferation. The use of negative pressure treatment can decrease the number of dressing changes and length of hospital stay. However, some related complications after and during VAC therapy have been described. We here describe a rare complication during the treatment of severe os ischium sore with VAC therapy, which has not been reported in the literature yet. We report about a 43-year-old paraplegic patient, referred to our clinic from a regional hospital where he had been admitted 2 months earlier, presenting with a necrotizing fasciitis after VAC therapy during the treatment of fourth grade os ischium sore. After operative debridement and long-term antibiotics with Ciprofloxacin soft tissue closure was performed using a myocutaneous tensor fascia lata flap. Temporary stabilization was achieved by a triangle external fixateur attached to the right femur and the pelvis. After 1 week the tapping point of the muscle flap could be covered with local skin mesh-graft from the right calf as a donor site. The patient was mobilized in a wheelchair and was discharged home 3 months after admission. The VAC technique is a safe, easy, and effective means in chronic wound care management. However, the described rare complication should be kept in mind. The clinical management of VAC therapy requires a distinct indication and close clinical monitoring by experienced medical professionals. The use of VAC therapy in fourth grade sores may have deleterious consequences for the patient.

Bacteriology of pressure ulcers in individuals with spinal cord injury: What we know and what we should know

“…Common characteristics between necrotizing soft tissue infections in individuals with and without SCI are that the perineal region is most often affected, and the infection is typically polymicrobial with as many as four different species of bacteria identified by routine bacterial methods. [71][72][73][74] In individuals with necrotizing fasciitis without SCI, streptococcal species was the most common bacteria identified, which were followed by Bacteroides, staphylococci, and enterococci. 73 Similarly, in studies of individuals with SCI with necrotizing fasciitis or Fournier's gangrene, streptococci was most commonly identified.…”

“…75 However, P. aeruginosa was also commonly identified in individuals with necrotizing fasciitis and SCI, an organism not typically identified in individuals without SCI. 71,76 Individuals with grade III and grade IV pressure ulcers, characterized by full thickness tissue loss and the presence of nonviable tissue, are at increased risk of developing necrotizing soft tissue infections. 75,76 Often, pressure ulcers associated with osteomyelitis are cultured positive for Gram-negative bacilli and anaerobes.…”

Use of negative pressure wound therapy in pediatric oncology patients: a single-center review of 66 patients

“…There was no evidence that the infection was due to the use of NPWT in this case. There was a reported case [24] of necrotizing fasciitis in an adult paraplegic patient which occurred after NPWT for treatment of a debrided grade IV ischial pressure ulcer. The authors believed that the patient's underlying osteomyelitis and his prolonged wound VAC dressing change regimen (the dressing sponge was only changed every 5 days rather than the recommended 2 to 3 days regimen) may have contributed to the development of necrotizing fasciitis.…”

Pressure ulcer management and research priorities for patients with spinal cord injury: Consensus opinion from SCI QUERI Expert Panel on Pressure Ulcer Research Implementation

“…PU sur geries have been associated with wound dehiscence, postoperative hematoma/seroma, necrotizing fasciitis [105] , and development of new intraoperative PUs. The incidence and prevalence of these complications are va riably defined.…”