A 54 year old patient presented with a
Madelung disease. Symmetrically fatty deposits were present on both upper arms, at the abdomen and both thighs.
Dermatitis was seen in the axillary fold at the skin bearing surfaces. Shoulder movement was impaired.
Liposuction of both upper arms has already been performed, but no significant improvement was obtained.
METHODS AND RESULTS: We performed a dermolipectomy of both upper arms. Postoperatively the patient suffered from a severe
wound dehiscence with fulminant
wound infection and septic clinical condition. Because of the large
wound surface ((1/3) of the upper arm circumference)
anemia occurred and had to be treated with
blood transfusions.
Wound exsudation caused a general
hypoproteinemia. Multiple surgical
debridements were necessary in order to clean the
wound from necrotic tissue and afterwards moist dressings were applied. Furthermore the patient received intravenous
antibiotic treatment. After stabilisation of the general condition of the patient and the
wound situation a
polyvinyl sponge and a vacuum-sealing were applied and continuous suction was performed (125 mm Hg). This resulted in a significant improvement of the
wound situation in regards to
wound cleaning, induction of granulation tissue, diminished
wound size, reduction of oedema and
pain reduction. After four weeks of vacuum
therapy defect coverage was possible and split thickness
skin grafting was performed. The skin graft was attached to the
wound using a vacuum-dressing. After removal of the vacuum dressing on the fifth day the skin graft has completely healed.
DISCUSSION: Vacuum
therapy is suitable for disastrous
wound conditions in order to achieve a defect size reduction,
pain reduction and create a clean
wound with granulation tissue for further surgical defect coverage using skin grafts or flaps.