Vaccum-therapy for treating a wound of difficult anatomic location in a 17-year old boy with systemic arthritis

BACKGROUND: Vacuum therapy (VAC^© Therapy, NPWT) is an effective method for treating wounds. Its principle is the following: a wound is covered with an airtight dressing, and negative pressure (50–125 mm Hg) is applied. Vacuum therapy is recommended for treating complex wounds.

CLINICAL CASE DESCRIPTION: In 2017, a patient, born in 2005, was diagnosed with “Juvenile arthritis with systemic onset, activity grade 2–1, X-ray stage 3, functional class 2”. Since then, he has been treated with immunosuppressants and corticosteroids. On November 9, 2022, edema, hyperemia, and hyperthermia of the medial half of the right gluteal region developed under immunosuppressive therapy. On November 11, 2022, necrotic discharge from the wound in the right gluteal region was noted. Diagnosis “Necrosis of subcutaneous fat of the right buttock spreading to the scrotum root” was put. On November 16, 2022, MRI was performed — a picture of widespread edema of fatty tissue to the right, in pararectal and gluteal regions with purulent content was revealed. The patient was transferred to the surgical department. Surgical debridement was performed under general anesthesia, and apparatus Suprasorb CNP P1 with intermittent negative pressure was put. On postoperative day 9, a stable positive effect was achieved in the form of wound healing with a tendency to secondary intention. During the wound revision on December 2, 2022, wound edges were clean; on December 16, 2022, the wound had a skin defect about 5×7 cm and no granulation in the wound depth. The wound was sutured. At the control examination on February 23, 2023, complete wound healing was seen.

CONCLUSION: Vacuum therapy is an effective tool for managing complex wounds in pediatric surgery which leads to positive outcomes. At the same time, such outcomes largely depend on the whole set of measures, including adequate surgical debridement, careful monitoring and appropriate antibiotic therapy. Comorbidities also play their role in the disease process.