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Case Reports
. 2022 Aug 30;16(1):335.
doi: 10.1186/s13256-022-03521-5.

Hypergranulation over a meshed split-thickness skin graft, a complication of negative-pressure wound therapy: a case report

Masato Shiba  1 , Tomoaki Doi  1 , Hideshi Okada  2 , Ryo Kamidani  1 , Genki Yoshimura  1 , Keigo Kusuzawa  1 , Fuminori Yamaji  1 , Tomotaka Miura  1 , Hideaki Oiwa  1   3 , Yosuke Mizuno  1 , Ryu Yasuda  1 , Tetsuya Fukuta  1 , Yuichiro Kitagawa  1 , Takahito Miyake  1 , Takahiro Yoshida  1 , Shozo Yoshida  1   3 , Shinji Ogura  1
Affiliations
Case Reports

Hypergranulation over a meshed split-thickness skin graft, a complication of negative-pressure wound therapy: a case report

Masato Shiba et al. J Med Case Rep. .

Abstract

Background: We present a case of a rare complication of negative-pressure wound therapy (NPWT) wherein there was fixation of a meshed split-thickness skin graft (STSG), suspected as a failure by hypergranulation. However, the meshed STSG was integrated within 5 days of NPWT cessation.

Case presentation: A 22-year-old Asian man sustained 25% total-body-surface-area flame burns. After multiple operations, an ulcer was present on the proximal left thigh. On day 37 after admission, the ulcer was debrided, and an 11/1000-inch (0.28 mm) skin graft was taken from the ipsilateral thigh and meshed, using a 1:1.5 ratio. NPWT was applied to the donor and recipient sites with a continuous negative pressure of 125 mmHg. On day 43, NPWT was discontinued. The skin grafts were not identified on the surface of the granulation tissue. With topical ointment therapy, rapid epithelialization of the ulcer was observed as the granulation tissue regressed. On day 48, the recipient site had completely epithelialized.

Conclusions: The hypergranulation tissue rarely covered the meshed STSGs when the grafts were fixed by NPWT. In that case, immediate debridement should be avoided, and conservative treatment should be initiated.

Keywords: Debridement; Hypergranulation; Mesh; Negative-pressure wound therapy; Split-thickness skin graft.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Pre- and intraoperative states of the left thigh. Day 1: the patient’s left thigh with a burn. Day 36: the proximal graft failed, resulting in an ulcer (arrow). Day 37: intraoperative appearance of the skin graft and negative-pressure wound therapy (NPWT). The meshed split-thickness skin graft (STSG) was fixed, and NPWT was applied to both the donor and recipient sites
Fig. 2
Fig. 2
Postoperative state of the left thigh. Day 43: (Left) Immediately after NPWT was discontinued: the recipient site was covered with granulation tissue (arrow). (Right) Small islands of epithelialization were visible under the granulation tissue after the irrigation (arrow). Day 48: Epithelialization of the recipient site was almost completed (arrow)
Fig. 3
Fig. 3
Possible mechanism underlying the phenomenon involving covering of the skin graft with granulation tissue. Negative pressure was applied to the healthy granulation tissue through the skin graft interstices, which resulted in the rapid growth of hypergranulation tissue and the formation of a hypergranulation layer
See this image and copyright information in PMC

References

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