PMC6796597_01
Large, indurated mass on the right hip/flank spontaneously draining purulent fluid (patient is positioned in left lateral decubitus).
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Upon physical exam there was found to be a large, indurated, fluctuant mass on the right hip/flank which was spontaneously draining pus from a small opening (Fig. 1).
Trans spatial, multiloculated fluid collection containing gas bubbles, extending through the right abdominal side wall involving the retroperitoneal space, abdominal/pelvic side wall musculature, and in the subcutaneous fat compatible with abscess.
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Computed tomography (CT) demonstrated a trans-fascial, multi-loculated fluid collection containing gas bubbles, extending through the right abdominal sidewall involving the retroperitoneal space, abdominal/pelvic side wall musculature, and in the subcutaneous fat compatible with abscess (Fig. 2).
Wound defect after extensive debridement measured to be 19 cm x 20 cm x 20 cm. Clear muscle and soft tissue involvement noted.
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The wound defect was measured to be 19 cm x 20 cm x 20 cm (Fig. 3).
Wound VAC applied to wound defect after drainage and debridement to prepare the wound for second look and closure.
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Due to the large defect and grossly contaminated operative field, a negative pressure wound dressing, vacuum assisted closure dressing (VAC) was applied to prepare the wound for a secondary examination and delayed primary closure (Fig. 4).