Description of Past Management: The skilled nursing facility packed the wound daily with an enzymatic debrider and saline moistened gauze. Upon evaluation, the wound measured 18cm x 8cm x7cm. Sixty percent of the wound bed was necrotic. Fractured coccyx and bowel were exposed in the base of the wound. Patient had a 45lb weight loss since surgery, and was deconditioned.
Current Clinical Approach: The patient was admitted to acute care for a comprehensive nutritional assessment, treatment for osteomyelitis and preparation of the wound bed with NPWT. After one week, a thin, fenestrated acellular human dermal matrix was placed in the wound bed and NPWT applied. The goal was to create protection for the bowel, stimulate healthy granulation tissue and minimize plastic surgery procedures.
Conclusions: Bioengineered tissue may provide an alternative option for patients who are poor candidates for gracilis flaps.