University of Texas Medical Branch, Galveston, TX.
Wounds. 2020 Apr;32(4):E27-E30.
This case report explores an effective treatment modality in a medically complicated patient, with considerable wound dehiscence refractory to treatment with negative pressure wound therapy (NPWT).
A 35-year-old woman with a past medical history of hypothyroidism, osteoporosis, and rheumatoid arthritis treated with tumor necrosis factor (TNF) alpha inhibitors and disease-modifying antirheumatic drugs presented to the clinic following right great toe arthrodesis, metatarsal neck osteotomies, extensor tendon lengthening, and capsulotomy of the second, third, fourth, and fifth toes 2 weeks prior, with wound dehiscence of the right great toe and subsequent exposure of surgical hardware, complicated by infection. At the 2-week postop, a urinary bladder matrix was placed on the wound following failed NPWT, which was in place for 10 days. At the 3-month follow-up, the wound was closed and without any drainage. Patient reported a significant reduction in pain (visual analogue scale: 3) with adherence to weight-bearing restrictions.
Wound healing was accomplished without removal of the exposed deep hardware in a patient with comorbidities and post-surgical wound dehiscence.
本病例报告探讨了一种针对患有多种疾病且术后伤口裂开的复杂患者的有效治疗方法，该患者对负压伤口治疗（NPWT）的治疗具有相当的抵抗力，效果不佳。
一名 35 岁女性，既往有甲状腺功能减退症、骨质疏松症和类风湿性关节炎病史，接受肿瘤坏死因子（TNF）α抑制剂和改善病情的抗风湿药物治疗。该患者于 2 周前行右大脚趾融合术、跖骨颈截骨术、伸肌腱延长术和第二、三、四、五脚趾囊切开术，术后出现右大脚趾伤口裂开，随后出现手术硬件暴露，并伴有感染。术后 2 周，在 NPWT 治疗失败后，在伤口上放置了尿路上皮基质，持续使用了 10 天。术后 3 个月随访时，伤口已闭合，无引流。患者报告说，在遵守负重限制的情况下，疼痛明显减轻（视觉模拟评分：3）。
在患有多种合并症和术后伤口裂开的患者中，无需取出外露的深部硬件即可实现伤口愈合。
