Reconstruction of gluteal defects related to Nicolau Syndrome secondary to intramuscular injection of diclofenac sodium with negative pressure wound therapy followed by skin graft.

Abstract

Objective: Nicolau syndrome, synonymously livedo-like dermatitis or embolia cutis medicamentosa is a rare complication of drug injection leading to locoregional necrosis of the skin, adipose and muscular tissue. Underlying physiopathology is not well unserstood and there is no standart guideline for its management. However, after the demarcation of necrosis, debridement and for large wounds reconstruction is mandatory. Even though vast majority of the Nicolau syndrome cases were reported by other disciplines but the plastic surgery, there may be further need for reconstructive procedures for wound closure.

Material and Methods: Present study included eight patients admitted to our wound care center for necrosis at the gluteal region after intramuscular injection of diclofenac sodium who were treated with debridement, negative pressure wound therapy and skin grafts. Patients’ ages, genders, body mass indexes, underlying diseases were documented. Sizes of the lesions were measured.  Injection, hospitalization, skin graft operation and discharge dates were recorded.

Results: All the wounds healed uneventfully but with depressed scars. Mean duration of hospitalization was 23.5 (range, 15-34) days.

Conclusion: In the present article, we reported that even if the hospitalization time is longer and cosmetic result is poorer, skin grafting after sufficient times of vacuum assited wound therapy administration is a reliable method. We do not recommend this method as the first choice but if there is not adequate adjacent soft tissue for harvesting  flaps or if a suitable perforator vessel is not found for  peforator flap harvest, this reliable method should be kept in mind.

Keywords

• Nicolau syndrome,Diclofenac; Gluteal defect; Negative pressure wound therapy,Skin graft

Reconstruction of gluteal defects related to Nicolau Syndrome secondary to intramuscular injection of diclofenac sodium with negative pressure wound therapy followed by skin graft

Öz

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