Treatment of a Chronic, Nonhealing Neuropathic Ulcer in a Pediatric Patient With Spinal Dysraphism: A Case Report
Ameya Deepak Joshi1, Sumedh Narayan More1, Amit Subhash Mhambre1
1All Institute of Physical Medicine and Rehabilitation, Mumbai, India.
Abstract:
A neuropathic ulcer results from repetitive trauma to a hyposensitive distal extremity, usually on a weight-bearing bony prom-inence. In addition to neuropathy, deformities and adapted walking patterns increase the risk of these wounds in children with spinal dysraphism. Information about treatment strategies for these wounds is limited.
Purpose:
The purpose of this case study was to describe the management of a chronic, nonhealing neuropathic ulcer on the dorsum of the left foot of an 11-year-old boy with spinal dysraphism.
Methods:
Autologous platelet-rich plasma (PRP), obtained using a double centri-fuge technique, was applied weekly underneath a nonadherent dressing and a below-knee plaster of paris cast. Complete non-weight-bearing was encouraged.
Results:
The patient presented with a 9 cm2 wound and a Pressure Ulcer Scale for Healing (PUSH 3.0) score of 13, which was of 6 months' duration. For the first 3 weeks, the autologous PRP and plaster cast were applied weekly. After 3 weeks, the wound was 2.25 cm2 (PUSH score 7) and treatment was changed to moistened saline dress-ings underneath the cast. The wound was healed after 5 weeks. No adverse effects were observed.
Conclusion:
Studies are needed to evaluate the safety and effectiveness of autologous PRP in neuropathic ulcer management in pediatric populations and to obtain evidence for optimal management of these wounds in persons with spinal dysraphism.
