NEGATIVE PRESSURE WOUND THERAPY IN THE TREATMENT OF SEVERE LEG INJURY IN 2-YEAR-OLD CHILD - CASE REPORT

Natalija Cokleska; Sanja Gjorikj; Arben Karpuzi; Lazar Todorovikj; Zlatko Aleksovski; Martina Kitanovska; Shaban Memeti; Marjan Kamiloski

Natalija Cokleska University Clinic for Pediatric surgery, Faculty of Medicine, Ss. “Cyril and Methodius”University Skopje, North Macedonia
Sanja Gjorikj University Clinic for Pediatric surgery, Faculty of Medicine, Ss. “Cyril and Methodius”University Skopje, North Macedonia
Arben Karpuzi General Hospital 8thSeptember, Skopje, Faculty of Medicine, Ss. “Cyril and Methodius”University Skopje,North Macedonia
Lazar Todorovikj University Clinic for Pediatric surgery, Faculty of Medicine, Ss. “Cyril and Methodius”University Skopje, North Macedonia
Zlatko Aleksovski University Clinic for Pediatric surgery, Faculty of Medicine, Ss. “Cyril and Methodius”University Skopje, North Macedonia
Martina Kitanovska University Clinic for Pediatric surgery, Faculty of Medicine, Ss. “Cyril and Methodius”University Skopje, North Macedonia
Shaban Memeti University Clinic for Pediatric surgery, Faculty of Medicine, Ss. “Cyril and Methodius”University Skopje, North Macedonia
Marjan Kamiloski University Clinic for Pediatric surgery, Faculty of Medicine, Ss. “Cyril and Methodius”University Skopje, North Macedonia

Abstract

Background: Negative pressure wound therapy (NPWT) is used for treatment of different type of acute and chronic wounds. This technique is commonly used for management of extremity soft tissue injuries. Sub-atmospheric pressure, from 75 to 125 mmHg is used in order to increase the blood flow and granulation tissue formation, to decrease the risk of infection by improving the bacterial clearance.

Case report: We report a case about 2-year old girl, a victim in a high-energy motor vehicle accident. Despite other injuries, the most important was a severe wound on left popliteal region. The wound underwent detailed exploration. There were evident signs of skin ischemia. There was partial laceration of biceps femoris muscle and lacerated subcutaneous blood vessels. Debridement for the necrotic tissue and reconstruction of the injured muscle were performed. Up to the 15th post injury day, there was a complete demarcation of necrotized zone of left popliteal region and proximal part of the lower leg. A wide skin, subcutaneous tissue and deep soft tissue structures surgical excision was performed. After the surgical debridement, VAC wound dressing was used for wound closure. After nine cycles of NPWT the wound was ready for skin grafting.

Conclusion: NPWT is successful and safe treatment for child injuries. This type of treatment shows many advantages, such as decreased morbidity, pain, cost, duration of hospitalization, antibiotic usage, analgesics usage, risk of infection, while, the patient comfort, esthetic and functional result are highly increased.

Keywords: Vacuum assisted closure, Negative pressure wound therapy, Sub-atmospheric pressure dressing

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