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Treatment of Chronic Wounds with a Modified Vacuum Assisted Closure Device and Allograft in a Patient with Recessive Dystrophic Epidermolysis Bullosa
Suzanne Inchauste, MD, Douglas Dembinski, MD, Andrew Parrish, BA, Elizabeth Lax, MD, Ann Schwentker, MD
University of Cincinnati
2018-02-12
Presenter: Douglas Dembinski, MD
Affidavit:
I certify the project represents original work of the residents and authors on this project.
Director Name: Ann R. Schwentker
Author Category: Resident Plastic Surgery
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. Minor mechanical trauma results in blistering of skin and mucosa. Patients with RDEB struggle with chronic wounds, and have an increased risk of cutaneous malignancies especially squamous cell carcinoma (SCC).
Case:
A 23-year-old female with RDEB who previously underwent a Symes amputation of the right foot for SCC developed worsening non-healing wounds on her left foot.
Challenge:
Minor trauma from wound cleaning and dressing changes can damage surrounding normal skin, worsening the wounds in patients with RDEB.
Innovation:
We previously utilized a modified vacuum assisted closure dressing (VAC) for wound care in a RDEB patient for extremity reconstruction after SCC resection. We utilized similar VAC dressing technique to treat this patient's chronic left foot wounds. The patient was admitted and had the VAC dressing applied at bedside. The skin between the wounds was dressed with bacitracin and Adaptic for protection. Mepitel transfer and DuoDERM were placed to the surrounding skin as a surface for VAC drape attachment. The wounds were dressed with black sponge VAC and attached to wall suction to achieve adequate compression. The VAC was changed every other day for one week until healthy granulation tissue appeared. Allograft was placed and adhered after 3 days of VAC therapy, then home dressing care of Mepitel and gauze was initiated. The patient's wounds demonstrated healing.
Conclusion:
Modified VAC can be used to aid wound healing in RDEB patients with chronic wounds.
