A 25-year-old male with colitis ulcerosa treated with prednisone was transferred to our department with a soft tissue defect at the left neck and upper left thorax after local necrosis following an abscess due to an erroneous puncture of a central line (Figure 2a ). After several debridements, applying vacuum- and antibiotic therapy combined with continuing a low dose prednisone therapy, the wound was vital and microbiologically free of bacteria. As reconstructive surgery, we decided to perform a supraclavicular artery island flap. The postoperative wound healing process showed no signs of infection with only a minor dehiscence at the drainage area so that we could discharge the patient with a good reconstructive result (Figure 2b ).\nHowever, following the necessity of increasing the prednisone therapy due to an acute period of colitis ulcerosa, the patient presented himself again 3 weeks after being discharged with multiple dehiscence around the elevation site of the supraclavicular flap with serous outflow. The microbiological tests showed no evidence of bacteria. After multiple debridements, the secondary wound was covered with skin grafts using MatriDerm® as dermal matrix (Figure 2c, d ). The young, immunocompromised patient could finally be discharged after an overall hospitalization stay of more than 12 weeks.
A 53-years-old male patient was presented to our department with a massive hand phlegmon arising from a small skin lesion a week earlier. Despite the swelling, redness and pain, necrotic areas were also present. However, due to chronic hepatitis C the patient was immunocompromised with interferon and ribavirin therapy. After performing a first debridement with necrectomy of the affected skin and soft tissue, vacuum therapy was applied. After several debridements with finally sufficient granulation, we decided to cover the defect by performing a radial forearm flap. This procedure could be successfully done after another period of vacuum therapy as the patient suffered from ascites and his general health conditions worsened due to his liver cirrhosis. The patient could finally be discharged after 7 weeks with good wound healing and recovery from the ascites.