Clinical case of the use of vacuum therapy in pediatric surgery for the treatment of complex wounds

Introduction. The use of vacuum therapy (VAC© Therapy, NPWT) has proven itself in the treatment of wounds. The method is based on the impact on the wound of negative pressure (50-125 mm Hg) through a hermetic bandage. Vacuum therapy is recommended for the treatment of complex wounds.Description of the observation. A patient born in 2005 with a diagnosis of juvenile arthritis with systemic onset, activity grade 2-1, x-ray stage 3, functional class 2, established in 2017, has been treated with immunosuppressants and corticosteroids since 2017. On November 9, 2022, edema, hyperemia, and hyperthermia of the medial half of the right gluteal region developed against the background of immunosuppressive therapy. Since 11.4.2022, necrotic discharge from the wound in the area of the right gluteal region has been noted. The diagnosis was made: necrosis of the subcutaneous fat of the right buttock with spread to the root of the scrotum. On November 16, 22, MRI was performed - a picture of widespread edema of fatty tissue in the pararectal and gluteal region, the perineum on the right with the presence of purulent contents was revealed. On November 16, 2022, the patient was transferred to the surgical department, surgical debridement was performed under general anesthesia and an intermittent negative pressure apparatus Suprasorb CNP P1 was applied. On the 9th postoperative day, against the background of the therapy, a stable positive effect was achieved in the form of wound healing with a tendency to secondary healing. During the revision of the wound from December 2, 2022, the edges of the wound were clean; on December 16, 2022, the wound was represented by a skin defect measuring about 5x7 cm with no granulations in the depth of the wound. The wound is sutured. At the control examination on February 23, 2023, complete healing was noted.Conclusion. Vacuum therapy is effective for the treatment of complex wounds in pediatric surgery, and allows you to achieve a positive result. At the same time, the result largely depends on the whole complex of measures, including adequate surgical debridement, careful monitoring and appropriate antibiotic therapy, and also depends on comorbidities.