Application of suction assisted closure to repair refractory ulcers of leukemia in children

Abstract

Objective To investigate the effect of suction assisted closure (SAC) in treatment of children′s leukemia with refractory ulcers. Methods The clinical data of 15 children who had leukemia associated with refractory ulcers from January 2013 to April 2017 in Department of Orthopedics, Wuhan Children′s Hospital, Tongji Medical College of Huazhong University of Science & Technology were retrospectively analyzed.There were 8 males and 7 females, among whom 9 cases were acute non-lymphocytic leukemia and 6 cases were acute lymphoblastic leukemia.Patient′s ages ranged from 2 to 9 years old with the mean age of 6.2 years.There were 5 cases of refractory ulcers located in the medial side of thigh and 4 cases in the perineum and around anus, 3 cases in the ankle, 2 cases in the crus and 1 case in the lateral side of thigh.The refractory ulceration area varied from 2 cm×3 cm-7 cm×5 cm, and the depth varied from 0.6-1.8 cm.All the 15 cases were cultured with secretions, including 7 cases of Staphylococcus aureus, 4 cases of Escherichia coli, 2 cases of Klebsiella pneumoniae, 1 case of Pseudomonas aeruginosa, and 1 case with no bacteria detected.These children were transferred from Department of Hematology to Department of Orthopedics when there was no improvement in conventional therapy with the average treatment of 26 d (11-36 d). All of these children underwent SAC after thorough debridement.Secondary suturing of ulcers closure was performed or skin transplantation according to the recovery condition of ulcers. Results All the 15 patients of refractory ulcers achieved fresh granulation tissue after SAC treatment.Ten of them who had refractory ulcers could be sutured directly after once SAC treatment, and 5 cases who had refractory ulcers underwent SAC treatment again, in which 3 cases could be sutured directly, and the other 2 cases needed to reduce the wound area and autologous skin graft.All of these patients had refractory ulcers healed after SAC treatment, without any local or systemic complications. Conclusions SAC can bring the deep refractory ulcers into full drainage, protect the refractory ulcers against contamination, stimulate the growth of granulation tissue.SAC is a simple and effective method in treatment of children′s leukemia with refractory ulcers. Key words: Child; Leukemia; Suction assisted closure; Debridement