Individualized therapy for wounds: Cases study and review

This article reports two rare cases and reviews relevant literature to outline distinctive diagnostic and therapeutic approaches, aiming to provide a reference for colleagues in managing similar wounds. The first case involves a 6-year-old boy who developed necrosis of the penile and glans skin following circumcision. The main challenge in this case was selecting suitable repair materials to restore the wound and appearance without affecting penile erectile function or, importantly, penile development. Scrotal flap reconstruction was successfully employed to achieve these goals, with satisfactory results observed at a 16-month follow-up, showing good appearance and normal development. The second case is a 17-year-old male who, after a dispute, inflicted a stab wound on his right thigh with a rifle bayonet. The patient underwent four rounds of debridement and suturing at a local hospital, resulting in sinus tract formation and subsequent referral to our department. Our team performed four surgical debridements, complete excision of the sinus tissue, negative pressure wound therapy, and flap repair; however, the sinus tract recurred within 1–2 days post-suture removal. Bacterial cultures of wound secretions yielded negative or, alternatively, Clostridium perfringens, Staphylococcus aureus, or Enterococcus faecium Group D. The patient was transferred to a hospital in Beijing, where four surgeries using similar techniques were performed, yet sinus recurrence persisted at the same site post-suture removal. The patient was subsequently transferred back to our department. We repeated the debridement and repair procedures, but sinus recurrence continued after suture removal. Finally, we applied fire-needle therapy to cauterize the sinus tract opening, walls, and base, transforming the chronic wound into a third-degree burn, thereby activating a heat-induced healing mechanism. The wound eventually healed, achieving full recovery after 18 months. A 5-year follow-up showed no recurrence. Case one: Repair of Penile and Glans Skin Necrosis Following Circumcision