Staged Management of Extensive Suprapubic Wound Necrosis After Hysterectomy Using Negative Pressure Wound Therapy and Delayed Skin Grafting

Postoperative wound complications are a major clinical challenge, especially in patients with comorbidities such as overweight and diabetes mellitus. Extensive abdominal wall necrosis after gynaecologic surgery is uncommon but may lead to prolonged healing, increased morbidity and the need for complex reconstructive procedures. Negative pressure wound therapy (NPWT) is an effective option for complex surgical wounds, promoting granulation tissue, improving perfusion and reducing bacterial burden. This report describes the case of a 58-year-old woman with overweight status and Type 2 diabetes mellitus who developed extensive suprapubic wound dehiscence with associated tissue necrosis following hysterectomy and bilateral salpingo-oophorectomy performed for a giant uterine leiomyoma. Following surgical debridement, NPWT was started and maintained with scheduled dressing changes. Progressive improvement was observed, with wound size decreasing from about 20 to 10 cm in 30 days and robust granulation tissue formation. Once the wound bed was optimised, definitive closure was achieved with an autologous skin graft. This case supports the role of NPWT as a bridge therapy in managing complex postoperative gynaecologic wounds in high-risk patients. A multidisciplinary approach involving gynaecologists, plastic surgeons and wound care specialists was essential for a favourable outcome. NPWT should be considered a valuable option for selected gynaecologic patients with extensive wound complications.