A 31-year-old male with a history of post-traumatic stenosisectomy 14 years earlier and overweight.
Pneumococcal sepsis caused multiorgan failure (renal, respiratory, hematologic and hemodynamic) and admission to the Intensive Care Unit (ICU).
The patient remained intubated for 11 days and then transferred to the Internal Medicine ward.
Due to poor perfusion secondary to sepsis, necrotic lesions appeared in the upper and mainly lower distal limbs.
Initially assessed by vascular surgery, treatment with prostaglandins was indicated for 21 days.
After improvement of the general condition and disappearance of vital risk and after 7 weeks admitted to Internal Medicine, he underwent Plastic Surgery for treatment of residual necrotic lesions.
On admission to our service she presented multiple small lesions in forearms, hands and thighs that epithelized adequately with topical treatment.
As a major complication of left plantar necrosis with 10 importance existed in the plantar mute zone that was debrided in the hospitalization room, left plantar anesthesia, dry necrosis of 3rd, 4th and 5th fingers of the right foot.
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Surgical intervention for left and right pretibial plantar debridement and daily debridement in the room to reduce most sloughs and debridement was performed.
After 20 days of daily debridement in the patient's room, without local anesthesia (the patient had no pain due to plantar anesthesia and because it was necrotic tissue), V.A.C.® therapy was initiated to avoid a large wound coverage.
Polyurethane sponges (VAC GranuFoam®) were applied, with continuous negative pressure of 125 mmHg in the first 48 hours and then continued with intermittent negative pressure (5 minutes with aspiration and 2 without aspiration).
The first week, tapered sponges (VAC GranuFam Silver®) were used to improve the antibacterial effect given the persistence of slough.
The VAC container is abundantly exudated during treatment.
We used the VAC ATS® Therapy System.
Complete treatment lasted 20 days and sponges were changed 3 times a week.
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The patient was able to continue performing physiotherapy exercises during treatment, comfortably transporting his VAC® system in his hand, when he attended wheeled sessions.
The evolution was very favorable, with disappearance of residual sloughs, formation of granulation tissue of live red color, without appearance of superinfection and obtaining a suitable bed to receive a skin graft.
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One week after VAC® therapy was withdrawn, the patient underwent surgery to cover the left plantar defect with a partial thickness skin graft taken from the thigh on the same side, amputation of the 3rd, 4th and 5th residual skin graft.
The grafts were properly secured and the wounds healed well.
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The patient was discharged after 4 and a half months of hospitalization and 2 weeks after the skin graft coverage intervention.
Upon discharge, the patient was ambulation with help of a prescription.
Six weeks after discharge, the patient walked independently with the help of a special template placed by the podiatrist, although he required routine care by the podiatrist due to plantar anesthesia, which required strict monitoring of the skin.
