Successful Use of Negative-pressure Wound Therapy and Dermal Substitute in the Treatment of Gluteal Ecthyma Gangrenosum in a 2-year-old Girl

Abstract

Summary:Ecthyma Gangrenosum is a manifestation of Pseudomonas Aeruginosa infection, usually occurring in immunocompromised patients, which can be associated with Pseudomonas Aeruginosa bacteremia with potentially lethal outcome. The clinical appearance is of an inflammatory cutaneous lesion with a central necrotic spot; the lesion then rapidly progresses to a gangrenous ulcer with a gray-black eschar extending in the deep soft tissues. Treatment of Ecthyma Gangrenosum includes both aggressive systemic antibiotic therapy and surgical procedures. A 2-year-old girl affected by B-cell precursor acute lymphoblastic leukemia was admitted to our hospital for suspected sepsis; the diagnosis was later confirmed by blood cultures positive for Pseudomonas Aeruginosa. In the days following the diagnosis, the patient developed a necrotic lesion of the right gluteal area consistent with Ecthyma Gangrenosum. Aggressive surgical debridement was then performed, followed by negative-pressure wound therapy and reconstruction with dermal substitute and autologous skin graft, which were successful. Ecthyma Gangrenosum is a potentially lethal condition affecting especially immunocompromised patients; aggressive medical treatment with combination antibiotic therapy is warranted and multiple surgical procedures, including extensive surgical debridement and diverting colostomy, are needed. Various reconstructive techniques have been reported in the literature, although no gold-standard can be established to date. Since Ecthyma Gangrenosum lesions are characterized by the presence of both high inflammatory activity due Pseudomonas infection and extensive tissue loss, the association of negative-pressure therapy and dermal substitutes implant seem to have a rationale in the surgical treatment of Ecthyma Gangrenosum and should therefore be considered.

Ecthyma Gangrenosum in Children With Cancer: Diagnosis at a Glance: A Retrospective Study From the Infection Working Group of Italian Pediatric Hematology Oncology Association

“…The necrosis of the tissue in the outcome of EG is a problem of utmost importance, since delays the recovery from the infection and might challenge the quality of life of this setting of patients, even after healing of the lesion, due to the occurrence of To remove the infected necrotic tissue and to ameliorate the healing of the wound, in our experience a surgical debridement has been considered in most cases, especially for larger lesions with extensive necrosis and more aggressive disease, confirming a described approach. 30,31 The vacuum therapy, reported in some cases to promote faster healing of the wound bed, 32 has been also applied in 5 patients, and in 3 cases prevented the occurrence of deep scars. The treatment with hyperbaric chamber has been also attempted in 4 cases, with successful result in 2.…”

“…The vacuum therapy, reported in some cases to promote faster healing of the wound bed, 32 has been also applied in 5 patients, and in 3 cases prevented the occurrence of deep scars. The treatment with hyperbaric chamber has been also attempted in 4 cases, with successful result in 2.…”