Description of past management: All transplant patients are followed closely after transplant and assessed for breakdown of the mucocutaneous junction. Wound care is based on  moist wound healing principles. Pouching to contain the effluent has always been the goal of treatment.

Current clinical approach: The patient started with a mucocutaneous separation concurrent with the  start of treatment for an acute cellular rejection. The resulting wound failed normal pouching techniques and the NPWT was started to treat the wound and maintain a secure pouching system. Infection is common in the immunocompromised population and the patient started with a significant cellulitis further complicating treatment. The use of a silver foam augmented treatment of the wound and the resultant infection.

Patient outcomes: The patient was treated for 16 weeks with NPWT for the wound. The silver foam was used for two week intervals to treat the periwound signs of cellulitis. The patient was maintained on prograf for her baseline immunosuppression and a basal dose of corticosteroid for ongoing treatment of ACR.

Conclusions: The results of using the NPWT with silver foam were positive in this patient. The patient went on  to complete closure of the wound 16 weeks after the start of the NPWT. A pouching system was able to be maintained throughout the treatement of the wound. Achieving wound closure of a peristomal wound may  improve infection related morbidity in the pediatric transplant population.