Hypergranulation over a meshed split-thickness skin graft, a complication of negative-pressure wound therapy: a case report

Background We present a case of a rare complication of negative-pressure wound therapy (NPWT) wherein there was fixation of a meshed split-thickness skin graft (STSG), suspected as a failure by hypergranulation. However, the meshed STSG was integrated within 5 days of NPWT cessation. Case presentati...

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Bibliographic Details
Published in:Journal of medical case reports 2022-08, Vol.16 (1), p.1-335, Article 335
Main Authors: Shiba, Masato, Doi, Tomoaki, Okada, Hideshi, Kamidani, Ryo, Yoshimura, Genki, Kusuzawa, Keigo, Yamaji, Fuminori, Miura, Tomotaka, Oiwa, Hideaki, Mizuno, Yosuke, Yasuda, Ryu, Fukuta, Tetsuya, Kitagawa, Yuichiro, Miyake, Takahito, Yoshida, Takahiro, Yoshida, Shozo, Ogura, Shinji
Format: Article
Language:English
Subjects:
Case Report
Case reports
Debridement
Hypergranulation
Mesh
Negative-pressure wound therapy
Plastic surgery
Polyvinyl alcohol
Pressure ulcers
Skin
Skin & tissue grafts
Split-thickness skin graft
Tendons
Ulcers
Urinalysis
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Summary:Background We present a case of a rare complication of negative-pressure wound therapy (NPWT) wherein there was fixation of a meshed split-thickness skin graft (STSG), suspected as a failure by hypergranulation. However, the meshed STSG was integrated within 5 days of NPWT cessation. Case presentation A 22-year-old Asian man sustained 25% total-body-surface-area flame burns. After multiple operations, an ulcer was present on the proximal left thigh. On day 37 after admission, the ulcer was debrided, and an 11/1000-inch (0.28 mm) skin graft was taken from the ipsilateral thigh and meshed, using a 1:1.5 ratio. NPWT was applied to the donor and recipient sites with a continuous negative pressure of 125 mmHg. On day 43, NPWT was discontinued. The skin grafts were not identified on the surface of the granulation tissue. With topical ointment therapy, rapid epithelialization of the ulcer was observed as the granulation tissue regressed. On day 48, the recipient site had completely epithelialized. Conclusions The hypergranulation tissue rarely covered the meshed STSGs when the grafts were fixed by NPWT. In that case, immediate debridement should be avoided, and conservative treatment should be initiated. Keywords: Debridement, Mesh, Negative-pressure wound therapy, Hypergranulation, Split-thickness skin graft
ISSN:1752-1947
1752-1947
DOI:10.1186/s13256-022-03521-5