A 56-year-old female with a prosthetic left wrist implanted 8 years before due to chronic polyarthritis presented herself to our emergency department with a massive painful swelling and signs of hand phlegmon (Figure 3a ). Her daily medication was methotrexate and prednisolone. Methrotrexate was paused, while prednisolone was reduced and the pain therapy adjusted by the pain therapist. We immediately performed a first debridement with relieving incisions. Daily wound lavage and antibiotic treatment were initiated. With no tangible improvement of the local wound signs and continuously increasing white blood cell count, we decided to remove the prosthetic wrist (Figure 3b ), stabilizing the hand by external fixation. After two more debridements and wound closure, the patient could be discharged 4 weeks later with external fixation and ongoing low dose prednisolone. After full recovery, the patient was hospitalized again for the removal of the external fixation and for autologous wrist arthrodesis by performing a free fibula flap to the left wrist (Figure 3c ). Once more, the wound healing was not adequate and both, staphylococcus and enteroccus could be verified within the wound. Antibiotic therapy was adjusted and additionally, we performed a gracilis flap to close the wound on the left wrist (Figure 3d ). However, the elevation area of the flap on the lower limb showed wound healing problems requiring a debridement and local skin grafting for wound closure.\nWith an overall hospitalization of more than 14 weeks, we could finally discharge the patient. 6 months after the last procedure was performed, again the patient was transferred to our hospital with the status of an acute sepsis and encephalitis with the left wrist being the focus of infection. As life-saving procedure the left hand needed to be amputated at the distal forearm. Finally, the patient recovered from both sepsis and encephalitis and could be discharged from our clinic to rehab.
A 46-year-old male was presented to us with the fatal diagnosis of Fournier’s gangrene after receiving his first episodes of chemotherapy comprising of vincristine and prednisone due to a non-Hodgkin lymphoma. After an immediate debridement of the necrotic scrotal area reconstructive surgery was performed already two days later with loco-regional flaps from both sides. With good wound healing and stabilized overall condition, the patient could be discharged to rehab after being hospitalized for more than 12 weeks.