Kim S, Jeon HB, Kang DH. Negative pressure wound therapy with a fenestrated penrose drain for refractory seroma following ischial flap: A case report. World J Clin Cases 2025; 13(22): 107325 [DOI: 10.12998/wjcc.v13.i22.107325]
Corresponding Author of This Article
Hong Bae Jeon, MD, PhD, Professor, Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Dankook University College of Medicine, 201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Chungnam, South Korea. jeonhb110@dankook.ac.kr
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Negative pressure wound therapy with a fenestrated penrose drain for refractory seroma following ischial flap: A case report
Sungyeon Kim, Hong Bae Jeon, Dong Hee Kang
Sungyeon Kim, Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Cheonan-si 31116, South Korea
Hong Bae Jeon, Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan 31116, Chungnam, South Korea
Dong Hee Kang, Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan-si 31116, Chungnam, South Korea
Co-first authors: Sungyeon Kim and Hong Bae Jeon.
Author contributions: Kim S performed literature search and data collection, and wrote the manuscript; Kang DH made critical revisions related to important intellectual content of the manuscript; Jeon HB supervised the whole process of the study; All authors read and approved of the final manuscript.
Supported by Research fund of Dankook University in 2023, No. R202300627.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this report including all clinical images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong Bae Jeon, MD, PhD, Professor, Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Dankook University College of Medicine, 201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Chungnam, South Korea. jeonhb110@dankook.ac.kr
Received: March 25, 2025 Revised: April 4, 2025 Accepted: April 16, 2025 Published online: August 6, 2025 Processing time: 50 Days and 15.5 Hours
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.
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.
