(CS-114) Novel technique to overcome challenges associated with management of difficult perineal pediatric wounds using a Transforming Powder Dressing: Case Series

Mark Chaet, MD

Introduction: On average, 3.9 million pediatric surgeries are performed annually in the USA.¹ Five percent of surgical wounds develop infections or other wound complications, resulting in poor wound healing, and increased pain, hospital stay and treatment costs.² Postoperative care, including adequate wound management, is critical to ensuring successful outcomes.³

Methods: This pediatric case series involves 3 patients with difficult-to-dress perineal wounds which were converted to a novel Transforming Powder Dressing (TPD). We hypothesized that the addition of TPD would facilitate wound closure and reduce primary dressing changes.



Vulvar Tumor: 14-month-old female with rapidly growing prepubertal tumor, s/p tumor excision and reconstruction with rhomboid rotational flap. Post op course c/b suture line disruption on post-op Day 5, resulting in 3.8 x 3.2 cm wound with undermining. Patient to OR for placement of two silastic bands to allow drainage followed by TPD application. TPD topped-off every 3-4 days the first week and then once every 1-2 weeks.



Perianal fistula-in-ano: 5-month-old male with perianal abscess. Initially treated with I&D and antibiotics at 8-weeks old, c/b recurrent infections drained spontaneously through a persistent tract over next 3 months. Taken to surgery with fistula-in-ano requiring fistulotomy. TPD applied post-fistulotomy and re-applied at Day 6.Pilonidal Cyst: 18-year-old female with pilonidal cyst (3 distinct sinus tracts), surgically unroofed and debrided resulting in 6 cm x 2 cm x 2 cm painful wound. Packed with TPD to control pain first week post-op; secured with contact layer and gauze, rinsed on Day 6 and conventional dressings applied twice daily thereafter.

Pilonidal Cyst: 18-year-old female with pilonidal cyst (3 distinct sinus tracts), surgically unroofed and debrided resulting in 6 cm x 2 cm x 2 cm painful wound. Packed with TPD to control pain first week post-op; secured with contact layer and gauze, rinsed on Day 6 and conventional dressings applied twice daily thereafter.

Results: Vulvar Tumor: Complete epithelialization in 8 weeks; 6 primary TPD changes versus 112 (2x daily) with conventional dressings.

Perianal fistula-in-ano: Full closure achieved within 3 weeks with 2 primary changes versus 56 (2x daily) with conventional dressings.

Pilonidal Cyst: Full closure within 8 weeks. One TPD application (versus 14 with conventional dressings) during first week. Marked granulation tissue proliferation was observed after Week 1 and conventional dressings were used thereafter.

Discussion: All wounds healed with less than expected healing times and limited dressing changes, demonstrating the effectiveness of TPD in treating difficult-to-dress perineal pediatric wounds.