Interdisciplinary management of complex chronic ulcers using vacuum assisted closure therapy and "buried chip skin grafts"

History and admission findings: We report the case of a 68-year-old female patient who was admitted to the hospital with deranged blood sugar levels in a septic condition. Due to complex chronic ulcerations of both feet she was intended for major amputation of both limbs. Clinical findings on admission were a diabetic foot syndrome with stage DIV ulcerations according to the Wagner and Armstrong classification, partially visible tendons and phlegmon of the lower leg. Investigations and clinical course: Vascular diagnostic revealed arterial occlusive disease in the lower legs without chance of reconstruction. Enterococcus faecalis and Staphylococcus aureus were extracted in swabs from ulcers. After correction of metabolic status and antibiotic treatment radical debridement of all ulcers was carried out and vacuum assisted closure therapy (V.A.C.(R)) was initiated. All wounds showed good granulation tissue after four cycles of V.A.C.(R)-therapy. Interdisciplinary treatment with a plastic surgeon was initiated to accelerate epithelial closure. Using the "Buried Skin Chip" technique in combination with V.A.C.(R)-therapy epithelialisation was completed within four weeks. The patient recovered well and was fully independent on discharge. Discussion and Conclusion: A goal-oriented interdisciplinary setting can achieve preservation of extremities even in septic patients. The combination of buried skin chip grafts and V.A.C.(R)-therapy may be a feasible and promising procedure to achieve accelerated wound closure in those patients.