Negative-pressure wound therapy (NPWT) with ulcerated skin metastasis – a case report

Abstract

Introduction: The NPWT uses a vacuum to improve and enhance the tissue perfusion and thus the tissue proliferation and healing. Hence the vacuum assisted closure therapy should not be applied for neoplastic wounds. In rare cases, it can be used for patients with malignancies to promote a hygienic wound closure nevertheless. Case Report: A 78 year old patient was presented to our clinic with the history of a cervical swelling and dysphagia for 3 weeks. An MRI and an upper endoscopy revealed a midline exceeding squamous cell carcinoma (cT3 cN3) of the base of tongue. Therefore, a treatment with primary chemotherapy and radiation was recommended. Prior to commencing the radiotherapy (RT) the patient presented a purulent, necrotizing fasciitis at the region of the cervival metastasis. After surgical debridement, the skin lesion was treated with NPWT for 17 days and finally closed with split skin graft. The planned RT was performed afterward without any wound healing disorders or recurrent metastasis. 4 years later, the patient died from a local cancer recurrence without any sign of metastasis in the former surgically treated region. Conclusion: The NPWT improves the healing of acute and chronic wounds. Even in case of malignant wounds, the wound closure by means of NPWT can be helpful to set conditions for further tumor therapy.