PMC3370922_01
(a and b) Initial presentation of the wound. (c and d) Progression of the wound necrosis.
eplasty12e26_fig1.jpg
PMC3370922_01_eplasty12e26_fig1.jpg
F1
A 5-year-old white boy presented with soft-tissue cellulitis involving the soft tissue of the lower ear auricle and adjacent neck (Figs 1a and 1b) as a result of a brown recluse spider bite. The involved area progressed from cellulitis to necrosis of the skin of the lateral neck and lower auricular cartilage (Figs 1c and 1d).
(a and b) The wound after initial debridement. (c and d) A single layer of Acticoat was used as a contact layer for the negative pressure wound therapy dressing.
eplasty12e26_fig2.jpg
PMC3370922_01_eplasty12e26_fig2.jpg
F2
The wound was debrided again (Figs 2a and 2b) and cultures returned with methicillin-resistant Staphylococcus aureus sensitive to vancomycin and trimethaprim/sulfamethoxazole. Petersburg, FL) without the absorbent layer was used as a contact layer (Figs 2c and 2d), and polyurethane foam was used as the wound filler.
These images demonstrate the obstruction of the ear canal with Xeroform. (a) Gauze covered with an occlusive dressing. (b) The lower part of the wound is covered with a single layer of Acticoat, which serves to modulate the wound as well. (c) The entire dressing effectively controls the wound dynamics in a difficult location. Note the second catheter placed to irrigate the wound if heavy exudate is discovered.
eplasty12e26_fig3.jpg
PMC3370922_01_eplasty12e26_fig3.jpg
F3
The external auditory canal was dressed with Xeroform gauze (Fig 3a), and the auricle was incorporated into the dressing (Fig 3c). The polyurethane foam was placed directly adjacent to the canal beneath the overlying occlusive dressing (Fig 3c).
These images show the wound after negative pressure wound therapy treatment and the application of a meshed, split-thickness skin graft. The patient is awaiting ear reconstruction. (a) First stage wound closure with skin graft, (b) 1 year after wound closure, and (c) 3 months after first stage ear sulcus and lobule restoration.
eplasty12e26_fig4.jpg
PMC3370922_01_eplasty12e26_fig4.jpg
F4
It was closed with a meshed, split-thickness skin graft (Figs 4a-4b), and the patient had an uneventful recovery. The patient had a first-stage reconstruction of the ear lobule at 14 months after the injury (Fig 4c) and will undergo 1 more procedure to complete the sulcus restoration and removal of more of the split-thickness graft.