Negative pressure wound therapy with a fenestrated penrose drain for refractory seroma following ischial flap: A case report

Abstract

BACKGROUND

Patients with paraplegia are vulnerable to ischial pressure ulcers. Surgical treatments often lead to complications such as seroma and infection, necessitating repeated interventions that increase surgical difficulty. This case report aimed to introduce a novel treatment strategy combining negative pressure wound therapy (NPWT) with a fenestrated Penrose drain to manage refractory seroma in patients with a history of ischial pressure ulcers.

CASE SUMMARY

A 63-year-old woman presented with soft tissue defects on the left ischium and right trochanter. After surgical debridement, an inferior gluteal artery perforator (IGAP) flap was used to reconstruct the left ischium. NPWT was applied at a setting of 75 mmHg on postoperative day 3 owing to the development of seroma, combined with a fenestrated Penrose drain to facilitate effective drainage of serous fluid. A 54-year-old man presented with a 4 cm × 2 cm ulcer on the left ischium after previous excision and flap coverage. After thorough debridement, the IGAP flap was elevated, and NPWT with a fenestrated Penrose drain was implemented immediately postoperatively at 75 mmHg to promote drainage. Both patients achieved a stable recovery without complications.

CONCLUSION

NPWT combined with a fenestrated Penrose drain placement is a promising strategy for addressing refractory seromas in cases of complex pressure ulcers.

Keywords: Inferior gluteal artery perforator flap; Ischial sore; Negative pressure wound therapy; Penrose drainage; Postoperative complication; Pressure sore; Case report

Core Tip: Combining incisional negative pressure wound therapy (NPWT) with a fenestrated Penrose drain promotes wound healing and manages fluid accumulation in dependent areas. In paraplegic patients, the ischial area is particularly susceptible to fecal and urine contamination. This approach protects the ischial region from contamination and reduces the need for frequent dressing changes. The timing and pressure settings for NPWT can be flexibly determined based on flap circulation viability and accompanying procedures such as skin grafts. This report provides a reliable option for managing refractory seromas in cases of complex pressure ulcers.