Case report: The innovative use of modified vacuum dressing in post vulvectomy wound

We herein report a case of a 20-year-old nulliparous female that had congenital HIV and has been on HAART since birth. She presented with large, extensive and obstructive genital warts. The genital warts consisted of features in keeping with histological benign lesion condyloma acuminate.

She was surgically managed with a simple vulvectomy without anal sphincter and urethral involvement. The surrounding skin appeared unhealthy and with minimal subcutaneous fat leading to wound breakdown and necrosis.

Features of this case are discussed together with its implications, including the size and extensiveness of the warts, the possibility of underlying malignancy despite histology and delayed wound healing due to secondary infection and necrosis. Additional measures taken to promote wound healing were the use negative pressure dressings (vacuum dressing) - a not commonly used intervention in the vulva region in our department. In addition, this was a modified approach using alternative materials that allowed for exudate management, granulation and an opportunity for secondary closure and a cosmetically healed vulval wound.

In applying the principles of negative pressure wound therapy in a low resource setting we achieved shortened hospital stay, cost effective outpatient management, minimal dressing changes, better pain control, easy mobilisation and wound granulation and healing allowing for secondary closure with good cosmesis.