First known case of successful pressure ulcer treatment in a lung transplant patient with post-COVID-19 pneumonia
Abstract: Given the current COVID-19 crisis, multiple clinical manifestations and related complications of COVID-19 disease, especially in lung transplant patients following post-COVID-19 pneumonia, are a major challenge. Herein, we report the therapeutic course of the first reported case of sacrococcyx pressure ulcers (PU) in a 65-year-old male COVID-19 patient who underwent lung transplantation and developed a PU following surgery. We used a combination of regulated negative pressure-assisted wound therapy system (RNPT, six treatment courses, five days per treatment course), a skin tension-relief system (an intraoperative aid in minimising wounds caused by sacrococcygeal PUs) and a gluteus maximus myocutaneous flap to repair sacrococcygeal wounds. This successfully treated case provides a reference point for the treatment of similar cases. Declaration of interest: The authors have no conflicts of interest. This work was partially supported by the Health Commission of Hubei Province Scientific Research Project (no. WJ2021F106), the National Natural Science Foundation of China (no. 81601691).
coronavirus ● COVID-19 ● intraoperative ● lung transplantation ● myocutaneous flap ● negative pressure ● pneumonia ● pressure ulcer ● pressure sore ● regulated negative pressure-assisted wound therapy ● sacrococcyx ● SARS-CoV-2 ● tension-relief system ● top closure ● wound ● wound healing
COVID-19 is an acute respiratory infection caused by a new coronavirus (SARS-CoV-2) infection, which has caused a worldwide pandemic. It is mainly characterised by fever, cough, and myalgia or fatigue.1,2
Lung transplantation is an effective treatment method for chronic lung diseases in patients with post‑COVID-19 pneumonia. There are only five reported cases of lung transplantations in patients with COVID-19.3,4
Sacrococcygeal pressure ulcers (PUs) are areas of skin and soft tissue necroses caused by prolonged pressure on the sacrococcygeal skin, continuous ischaemia, hypoxia and malnutrition, and are more common in severely ill patients, including lung transplant patients, who have been bedbound for a long time.5
Regulated negative pressure-assisted wound therapy (RNPT system, Vcare α device, IVT Medical Ltd., Israel) and skin tension-relief system (TopClosure TRS, IVT Medical Ltd., Israel) are new clinical approaches in the adjuvant treatment of acute and hard-to-heal wounds.6,7 The combined application of the two methods is a new treatment approach for clinical acute and hard-to-heal wounds.8 The RNPT system is a simple, safe and
Yilan Tong,1 MD; Sijiong Yu,2 PhD; Kaijun Guo,2 PhD; Xiangsheng Wang,1 MD, PhD; Yang Wu,3 MD; Zhongyuan Xia,3 MD, PhD; Guang Li,4 MD, PhD; Haifeng Hu,5 MD; Mosheng Yu,1 MD*; Zhanyong Zhu,1 MD, PhD* *Corresponding author email: firstname.lastname@example.org; email@example.com 1 Department of Plastic Surgery, Renmin Hospital of Wuhan University, Wuhan, China. 2 Beijing University of Agriculture, Animal Science and Technology College, China. 3 Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China. 4 Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China. 5 Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China.
affordable technique which uses sub-atmospheric pressure as a non-pharmaceutical technology to protect and enhance wound healing. The drainage tube (negative pressure connection) is used to drain blood and exudate from the wound to promote healing and proliferation of wound granulation tissue.9 The TRS, which serves as a tension-relief platform, allows for the immediate or delayed primary closure of large skin defects which would otherwise require closure by skin grafts, flaps or tissue expanders.10
Our team successfully treated the first known case of sacrococcygeal PU that developed after lung transplantation in a patient with post-COVID-19 pneumonia, using the RNPT system, TRS and local gluteal muscle flap transfer.
The patient in this manuscript has given written informed consent for the publication of their case details.
The data used to support the findings of this study are available from the corresponding author upon request.
Case report A 65-year-old male presented to the clinic on 7 February due to intermittent fever for 15 days. His body temperature was 39.6°C, and his chest computed tomography (CT) scan showed lung infection, but no obvious cough or sputum was observed. The patient tested positive for COVID-19 nucleic acid. After six days of anti-infective treatment, there was no improvement; hence, he was admitted to the hospital. After three days, his condition worsened and he was transferred to the intensive care unit (ICU).
On 18 February, the patient was treated with extracorporeal membrane oxygenation (ECMO), during
JOURNAL OF WOUND CARE VOL 30, NO 8, AUGUST 2021