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Limb salvage in recessive dystrophic epidermolysis bullosa: filet-of-foot flap with placement of modified vacuum assisted closure dressing
Andrew Parrish, Suzanne Inchauste, MD, Anthony Vu, MD, Nataliya Biskup, MD, Ann Schwentker, MD
University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center
2017-01-30
Presenter: Andrew Parrish
Affidavit:
This material has not been previously published or presented. The innovation described was based on a case planned and performed by myself and the resident and fellow physicians listed as co-authors. The submitting and presenting student, Andrew Parrish, was involved in drafting and revising the abstract.
Director Name: Ann R. Schwentker, M.D.
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction:
Recessive dystrophic epidermolysis bullosa (RDEB) is a rare connective tissue disease characterized by defects in dermal-epidermal anchoring that results in blistering of skin and mucosa with minor mechanical trauma, chronic wounds, and an increased risk of cutaneous malignancies.
Case:
A 23-year-old female patient with RDEB presented with an invasive squamous cell carcinoma of her heel. Syme's amputation with a posterior tibial-based sensate, end-weight bearing flap was planned to preserve mobility and decrease the risk of skin breakdown.
Challenge:
The posterior tibial bundle could not be salvaged. Therefore, the flap was based on the dorsalis pedis (DP). There was subsequent partial flap necrosis and infection, leading to an exposed bony stump with questionable flap viability after debridement.
Innovation:
A vacuum assisted closure (VAC) dressing was used to clear infection, promote granulation tissue, and control edema. In order to utilize the VAC, Mepilex transfer was applied to the intact skin with DuoDERM over it. VAC sponge was placed into the wound and the DP flap was wrapped over the sponge. Adaptic was placed over the skin and draped with VAC drape. Wall suction was used because of a slight air leak through the Mepilex transfer, with good compression of the VAC sponge. Excellent granulation tissue was observed during VAC changes and the surrounding skin remained intact. The wound was later closed over a Penrose drain and the flap was salvaged.
Conclusion:
Modified VAC use in patients with RDEB can be used to improve healing without damaging surrounding, intact skin.
