Full-Thickness Skin Transplantation Combined with Negative-Pressure Wound Therapy for a Refractory Peristomal Large...

Stomal mucocutaneous separation is a frequent complication of colostomy, which may complicate wound care due to contamination from fecal leakage, resulting in delayed wound healing. In addition, systemic factors may further influence postoperative wound healing. We report successful combination treatment, involving full-thickness skin graft transplantation and negative-pressure wound therapy (NPWT) in a patient with a large peristomal ulcer that developed progressively in the postoperative course following complete circumferential mucocutaneous separation and infection, which occurred after neoadjuvant chemotherapy followed by laparoscopic abdominoperineal resection.

A 75-year-old male, who had been diagnosed with advanced low rectal cancer, received 4 cycles of mFOLFOX6 chemotherapy (oxaliplatin, leucovorin, and fluorouracil) plus bevacizumab, followed by laparoscopic abdominoperineal resection with lymph node dissection. Approximately 4 weeks later, partial mucocutaneous separation developed, accompanied by subcutaneous abscess formation. Subsequently, this led to complete circumferential mucocutaneous separation, which evolved into a giant peristomal ulceration with a significant tissue loss. Conservative local wound care, including frequent debridement, was continued, and granulation tissue gradually filled the peristomal skin defect. Three months after the operation, full-thickness skin graft transplantation combined with NPWT was performed. At 6 years after the operation, the patient remained recurrence-free, and there were no postoperative complications or issues with the colostomy or skin graft.

This combination therapy successfully treated a giant peristomal ulcer that progressively developed after mucocutaneous separation with infection, which occurred later than typical postoperative wound complications following neoadjuvant chemotherapy (mFOLFOX6 + bevacizumab) and laparoscopic surgery. Delayed wound healing, potentially related to bevacizumab, may have contributed to both the late onset and unusually extensive progression of the ulcer. The therapy proved compatible with long-term stoma care.