Background We present a deep neck infection associated with mediastinitis treated with VAC therapy. In this case we encountered exposure of the carotid sheath, and protected with GELFOAM® (Pfizer®) sponge and ACTICOAT FLEX 3® (Smith&Nephew®), as an alternative to petroleum gauze. Case summary A 29-year-old female with deep neck abscess and mediastinitis involving carotid sheath. Treated with VAC therapy, right thoracotomy and left thoracoscopy with decortication. During the VAC changes carotid sheath was covered by a layer of Gelfoam® and Acticoat flex3®. A total of 3 changes were performed with direct wound closure with no evidence of vascular direct injury. Conclusion The present case demonstrates that alternative dressing choices such as GELFOAM® and ACTICOAT FLEX3® can potentially be used instead of the classic petroleum gauze for Negative Pressure Therapy for wounds with exposed vessels. More prospective randomized trials should be performed to ensure this proposal safety. We believe that the microporous layer decreases the direct negative pressure in the vessels. We did not find complications related to this treatment, but we cannot assume they are nonexistent. Highlights

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Osteoid osteomas are benign skeletal tumors; more than half of the lesions occur in lower extremity long bones, with very few cases reported in metacarpal bones. We presented the case of a patient at the plastic surgery department of a regional hospital, who presented with a tender tumor in the left hand over the past 2 years.