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Case. A 69-year-old man presented with painful peristomal skin necrosis during cancer chemotherapy. He had undergone left hemicolectomy for obstructive ileus due to metastatic descending colon adenocarcinoma three months before the presentation. Physical examination revealed a 10 cm × 7 cm peristomal full thickness skin necrosis with a well-defined, undermined, violaceous border. Bacteriological examination of wound swab isolated enteric and skin bacteria. From the clinical appearance, peristomal pyoderma gangrenosum with secondary infection was suspected. Because he had no inflammatory bowel disease and was in the course of cancer chemotherapy, we started topical treatment without systemic administration of steroids. After daily cleansing with minimal debridement of the necrotic tissue, silver coated calcium alginate dressings were applied over the ulcer to manage the exudate with a skin barrier paste and a 2-piece pouch on. One month after the presentation, the necrotic tissue was removed and wound bed preparation was achieved with epithelialization of the 8 mm width from the mucocutaneous junction. Because his life expectancy was approximately six months, we performed a split thickness skin graft to heal the ulcer as soon as possible for the rest of his days. At the end of the operation, we used negative pressure wound therapy (NPWT) for graft fixation. At the first dressing change on the seventh postoperative day, the meshed skin graft was successful and the pouching system could be applied in the preoperative manner. One month after the operation, the ulcer was completely healed and he could manage the appliance by himself to be discharged.
Conclusion. This case report describes the successful surgical treatment and use of NPWT in the management of peristomal skin ulcer.