Based on untreated diabetes, a 69-year-old female patient was hospitalized for necrotizing fasciitis of the right thigh from the lower abdomen. After recovering from shock by antibiotic administration and general care, treatment of the remained ulcer was planned; however, it was judged that treatment with general anesthesia was difficult. Therefore, four gradual postage stamp skin grafts were performed at the bedside in combination with local anesthesia and negative pressure wound therapy. The skin grafts were taken completely, and no notable problems were found after the procedure. Gradual postage stamp skin graft bolstered with negative pressure wound therapy has the advantages of minimal invasion, high rate of graft take, and does not interfere with the main treatment. Although it has some cosmetic disadvantages, it is a useful method, especially for poor general conditions.
To close a highly contaminated wound, the wound environment should be controlled to suppress the infection. Early debridement and early wound closure are essential. However, it is difficult to remove residual foreign matter and manage the infection immediately in some cases. We encountered a case of an open, contaminated shoulder wound managed with intra-wound continuous negative pressure and irrigation treatment. Debridement was performed on the day of injury. However, the fine foreign substances were insufficiently removed, and a superficial infection occurred. Intra-wound continuous negative pressure and irrigation treatment were performed for wound management. The infection was controlled, and the wound was covered with a latissimus dorsi muscle flap. This study showed that intra-wound continuous negative pressure and irrigation treatment were viable wound management options for superficial infections and complex structures.
Dermatofibrosarcoma protuberans (DFSP) is a cutaneous fibrohistiocytic tumor of intermediate malignancy that typically arises in the dermis and subsequently infiltrates the subcutaneous tissue. Here, we present an extremely rare case of DFSP confined to an intramuscular lesion on the forehead. A 61-year-old female patient presented with a tender bicuspid subcutaneous mass on her forehead that had been gradually increasing in size for 10 years. The patient underwent surgical resection and pathological examination. Microscopically, cells with spindle-shaped nuclei and scant eosinophilic cytoplasm were arranged in a haphazard or monotonous pattern. However, no relationship was observed between the tumor and skin appendages. At the superficial margin, tumor cells infiltrated the surrounding frontalis muscle tissue, demonstrating typical DFSP morphology. In immunohistochemical studies, neoplastic cells were identified as anti-CD34 positive, which was a decisive diagnostic factor.
With the introduction of the RENASYS TOUCH negative-pressure maintenance and management device (Smith & Nephew plc, London, UK), the treatment of multiple wound sites using Y-connectors has become easier. In addition, the release of drainage accessories has expanded the treatment options. In this study, we combined the RENASYS wound therapy system with drains and incisional negative pressure wound therapy (NPWT) (diNPWT [tentative name]). The RENASYS TOUCH main unit, Y-connector, foam, and drain accessories were prepared. Conventional drain insertion was replaced by a drain accessory for wound closure after surgical treatment of intractable ulcers. After the drain accessory was placed, the wound was closed, a nonadherent dressing and foam were placed on the sutured wound, and the Y-connector was connected to the main unit. The patient was managed with a negative pressure of −80 to 100 mmHg for 5 to 7 days postoperatively. The drain accessory used in this study can adjust the pressure according to the instrument itself, and we believe that it can adhere to the lumen with stronger pressure. In addition, by applying NPWT to the sutured wound, postoperative misalignment stress can be avoided, and a good outcome can be obtained.
Introduction: Self-injurious behavior is one of the characteristic symptoms of Lesch-Nyhan syndrome. In severe cases, the patient's lips or tongue are often injured, but there are no reports of cases leading to infective endocarditis via bacteremia. There are non-invasive treatments for self-injurious behavior, but surgery is occasionally needed. Herein, we report a case of Lesch-Nyhan syndrome that required surgery to control self-injurious behavior. Case presentation: A 21-year-old boy with Lesch-Nyhan syndrome exhibited uncontrollable self-injurious behavior. He visited our hospital with a high fever. Physical examination revealed ulcerations on both his lips and tongue, and there was also a defect on his tongue. All blood cultures that were taken were positive. Vegetations were found on the heart valves through echocardiography, revealing that he has infective endocarditis. To prevent recurrence of ulceration, we performed total tooth extraction and glossectomy. After four months, there is no recurrence of ulcerations or infective endocarditis. Discussion: Although total tooth extraction is irreversible, invasive, and has a significant impact on the patient's appearance, it is a definite way not only to prevent ulcerations caused by self-injurious behavior but also to protect his life.