Outpatient negative pressure dressing therapy for pretibial lacerations in a patient with high anaesthetic risk: a case study

Pretibial lacerations are a common presenting complaint to plastic surgery units, representing approximately 5.2 in every 1000 presentations to UK accident and emergency departments.¹ These injuries commonly affect patients with medical comorbities, and whose skin durability is decreased by diabetes mellitus, corticosteroid use and/or peripheral vascular disease.² It is therefore not uncommon to encounter a patient with a pretibial laceration who is also a high risk surgical candidate. We demonstrate the complete closure of a series of three pretibial lacerations using outpatient negative pressure wound therapy (NPWT) in a patient with grown-up congenital heart disease (GUCHD).

A 49-year-old female patient was diagnosed in infancy with pulmonary atresia, a ventricular septal defect and major aortopulmonary collaterals. The patient underwent a Blalock-Taussig shunt at aged 18 years, and had a further shunt placed during her thirties. She subsequently developed pulmonary hypertension and had an episode of infective endocarditis in 2004, leaving her with persistent proteinuria. She describes an exercise tolerance, which allows her to complete 12 stair steps before requiring her to rest, and uses oxygen as required at home. She has peripheral cyanosis at rest, a known risk factor for perioperative complications in the GUCHD cohort,³ and her oxygen saturations are approximately 80% with a secondary polycythaemia.