A 54-year-old male with the following personal history: exalcoholic, ex-smoker, chronic obstructive pulmonary disease (COPD) classified as mixed respiratory incapacity moderate-severe, polymyocardial oesophagus, rheumatic hepatopathy, polymyalgia polyar.
Due to chronic corticosteroid treatment, in May 2010, the patient suffered an osteoporotic vertebral compression, which required surgery consisting of D2-D7 vertebral fusion and D4-D5 vertebroplasty.
One month later, the patient was admitted to our hospital with a diagnosis of transverse spinal cord injury syndrome D4 ASIA C for evaluation and rehabilitation treatment; this last aspect was impossible from the very beginning due to the instability of the vertebral lesion.
It was also necessary to perform daily local cures and every 2-3 days surgical wound dressings regulated, as it also presented an open, infected and sloughed wound in the upper dorsal spine.
In this way we tried to keep the osteosyntesis material and prevent the clinical evolution of its spinal cord injury.
Finally, in view of the impossibility of lowering the bacterial load of the wound and closing it, we decided to remove all the osteosynthesis material in October.
In January 2011, local antiseptic dressings were applied until an adequate wound bed was achieved. In January 2011, a pedigree flap was used to cover the existing defect.
In the immediate postoperative period of this intervention, untimely postural maneuvers were performed which iatrogenically produced venous congestion of the described flap.
We performed cutaneous debridement one month later. We placed two VAC® systems for a month: one hand-held craniotomy for the exudate in the muscle area and the other hand-held device.
We chose the black foam modality for the dressing (granufoam: 400 polyurethane condom for high pore pressure tissue infection) because it was a residual wound of relatively small local generation (4 x 5 cm).
The therapy was continuously installed at -125mmHg in the first 48 hours and then dropped to -75mmHg until the end of treatment.
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In March 2011 we covered with self-injectors the 3 previously described zones, already granulated and fixed them with a portable VAC® system of last generation (VIA®) for a week to continue the rehabilitation program mmHg.
