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.
A 60-year-old female with the initial diagnosis of acute myelogenous leukemia was presented to our clinic with an abscess and surrounding erysipelas on the left lower leg (Figure 4a ). A first excision and debridement of the soft tissue was performed exposing the extensor tendons with a defect size of 6x5 cm (Figure 4b ). Vacuum therapy was applied. Due to the initial and ongoing chemotherapy (idarubicin and cytosin-arabinoside) with a depleted hematological cell status, we decided not to perform a reconstructive procedure with a loco-regional or even free flap, but to repeat the debridement and vacuum therapy for the following 10 weeks. With a satisfying granulation of the wound, we finally closed the defect with skin grafts during a chemotherapeutic interval (Figure 4c ). Although, the wound healing was prolonged, the patient could be discharged with finally good results to receive further allogenic stem cell transplantation in an external clinic.