Negative pressure wound therapy-assisted dermatotraction for the closure of large open wounds in a patient with non-clostridial gas gangrene

Abstract

Case: A 53-year-old woman developed septic shock associated with non-clostridial gas gangrene. She presented to the emergency department with two large open wounds on both thighs and in her sacral region. Non-enhanced computed tomography showed air density in contact with the right iliopsoas, which extended to the posterior compartment of the thigh. We made repeated efforts at surgical debridement of the wound with resection of necrotic tissues.

Outcome: Using negative pressure wound therapy-assisted dermatotraction, the pus pockets and the wound dehiscence decreased in size. Using this method we were successful in achieving delayed closure without skin grafts.

Conclusion: Negative pressure wound therapy can be an effective treatment for large and infected open contoured wounds. Negative pressure wound therapy-assisted dermatotraction might be beneficial for poorly healing, large, open wounds in patients in poor condition and with insufficient reserve to tolerate reconstructive surgery.

Keywords: Dermatotraction; infection; negative pressure wound therapy; non‐clostridial gas gangrene; wound care.

Figure 1

A 53‐year‐old woman developed septic shock associated with non‐clostridial gas gangrene. On admission, non‐enhanced computed tomography showed air density in contact with the right iliopsoas muscle (A) (arrows), and air density extending from the wounds to the bone (B). Air density and fluid collection (arrows) were also noted in the posterior compartments of the thighs (C). The patient presented with a partially necrotized gluteus maximus (D). The extents of the pocket are illustrated (E).

Figure 2

Use of negative‐pressure wound therapy (NPWT) and NPWT‐assisted dermatotraction in a 53‐year‐old woman who was admitted with two large open wounds on both of her thighs and in her sacral region. After daily debridement (hospital day 2) (A, D), NPWT was applied to the large, open wounds (hospital day 4) (G). Dermatotraction (hospital day 10) (B, E); NPWT‐assisted dermatotraction (hospital day 10) (H) was used where the wound dehiscence had decreased in size. We successfully carried out delayed closure without skin grafts (hospital day 30) (C), (hospital day 35) (F), (hospital day 81) (I).

Figure 3

Gauze‐based negative‐pressure wound therapy. A, B, Non‐enhanced computed tomography demonstrated saline‐soaked gauze (arrows) placed into the contoured wounds and pus pockets with no dead space (hospital day 7).