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Reconstruction of Extensive Tissue Defect Due to Purpura Fulminans
Melis Cevhertaş 1, Hatice Donbaloğlu 1, Ülgen Çeltik 1, Kübra Cebeci 2, Pınar Yazıcı Özkaya 2, Bülent Karapınar 2, Mustafa Orkan Ergün 1
1 Ege University Faculty of Medicine Department of Pediatric Surgery
2 Ege University Faculty of Medicine Department of Pediatric Intensive Care
Background
Purpura fulminans(PF) is a life-threatening condition with disseminated intravascular coagulation(DIC) and extensive necrosis.Managing large (>40% body surface area(BSA) tissue defects in pediatric patients is highly challenging.
Case Description
A 9-month-old girl was admitted to intensive care unit(ICU) with extensive necrotic tissue loss involving 40% of BSA, including the anterior abdomen, back, bilateral gluteal regions, and left thigh, due to PF following gram-negative sepsis and DIC.
Initially, all necrotic tissues're debrided, and a dermal matrix, composite tissue covering made of bovine Type I collagen, was applied to support wound healing.A revision's performed 10 days later, followed by occlusive dressing with silver sulfadiazine.Once granulation tissue formation's observed, negative pressure wound therapy(VAC) was initiated in four sessions over a total of 30 days.This approach significantly enhanced granulation tissue growth and prepared the wound bed for grafting.
Subsequently, split-thickness skin grafts're harvested from the medial and lateral aspects of left leg and the back using dermatome blade.These grafts're expanded at 1:4 ratio and applied from anterior trunk to the back.Ten days later, autologous skin graft's applied in the same manner to remaining right lumbar region.
After 80 days in the ICU, the patient's transferred to the ward, where she's discharged home in good health on 2nd day of ward follow-up.
Conclusion
This case demonstrates the success of dermal matrix and intensive VAC therapy in treating extensive (>40%BSA) tissue defects.A staged skin grafting approach and multidisciplinary care ensured effective wound closure and functional recovery in this complex pediatric case.