Limb Salvage through Intermediary Wound Coverage with Acellular Dermal Matrix Template after Persistent Pseudomonas Aeruginosa Infection in a Burn Patient

Mateusz Gładysz,Stefan Ruemke,Evgenii Rubalskii,Nicco Krezdorn,Vincent März,Peter Maria Vogt

doi:10.3390/ebj3010004

Abstract

Secondary infections of skin grafts pose a continuous problem in burn patients, very often leading to loss of transplanted skin grafts and making multiple surgical revisions necessary. We present a case report about persisting Pseudomonas aeruginosa infection in burn patients with known diabetes. The burn wounds in lower extremities required repeated debridements, multiple skin grafting attempts and finally an application of the dermal scaffold NovoSorb BTM. With these measures, we managed to undertake a successful reconstruction of infected burn defects and pre-vent an amputation. We concluded that the NovoSorb BTM could be seen as an additional promising tool in a burn surgery armamentarium. In cases where radical surgical wound decontamination is not possible without risking the loss of the limb, the application of NovoSorb BTM over a contaminated field can win extra time for topical infection treatment and additionally provide an excellent skin grafting ground.

Highlights

Wound infections still pose a significant challenge in the successful treatment of deep thickness burn injuries
We report a 69-year-old diabetic patient who suffered from a deep partial thickness circumferential burn injury of both legs to an extent of 15% of total body surface area (TBSA)
After initial therapy and early debridement with immediate skin-graft coverage, we observed a progressive loss of skin graft due to local wound contamination with Pseudomonas aeruginosa

Summary

Introduction

Wound infections still pose a significant challenge in the successful treatment of deep thickness burn injuries. After initial therapy and early debridement with immediate skin-graft coverage, we observed a progressive loss of skin graft due to local wound contamination with Pseudomonas aeruginosa. 21 days of the integration phase, we performed a successful skin grafting and were able to transfer the patient with closed wounds to a burn rehabilitation clinic. Eventhough we applied diverse topical treatments with topical iodine solution, open wound treatment, or water filtrated infrared light we observed a progressing loss of skin grafts (Figure 1C). After early removal of foam dressing, we observed a persisting wound colonization with Pseudomonas aeruginosa and non-adherence of skin grafts (Figure 2A). After minimizing the Pseudomonas aeruginosa wound colonization, with measures listed above, we repeated a hydro-surgery debridement with Versa-Jet and covered the wounds with NovoSorb BTM polyurethane based dermal skin template (Figure 2C). Wounds. (B) Result after burn-rehabilitation with patient being able to freely walk again

Findings

Discussion

Conclusions