The use of negative-pressure wound therapy over a cultured epithelial autograft for full-thickness wounds secondary to purpura fulminans in an infant

Abstract

Purpura fulminans is a serious condition that can result in severe morbidity in the pediatric population. Although autologous skin grafts remain the gold standard for the coverage of partial-to full-thickness wounds, they have several limitations in pediatric patients, including the lack of planar donor sites, the risk of hemodynamic instability, and the limited graft thickness. In Singapore, an in-house skin culture laboratory has been available since 2005 for the use of cultured epithelial autografts (CEAs), especially in burn wounds. However, due to the fragility of CEAs, negative-pressure wound therapy (NPWT) dressings have been rarely used with CEAs. With several modifications, we report a successful case of NPWT applied over a CEA in an infant who sustained 30% total body surface area full-thickness wounds over the anterior abdomen, flank, and upper thigh secondary to purpura fulminans. We also describe the advantages of using NPWT dressing over a CEA, particularly in pediatric patients.

A bioreactor for studying negative pressure wound therapy on skin grafts

“…While we did not test CEAs, we are confident that we could test CEA by placing it on the same wicking material used for the ESS. The negative pressure would likely need to be reduced for CEA such as was reported by Goh et al 45 While this was designed for skin grafts, it could be used for additional tissues such as the muscle layer of the wound or possibly for wound interface studies. It is limited to a depth of approximately 6 mm; however, the thicker the tissue the more difficult it is to provide nutrients to the top layers.…”