title: Community-associated methicillin-resistant Staphylococcus aureus-infected chronic scalp wound with exposed dura in a 10-year-old boy: vacuum-assisted closure is a feasible option: case report.
abstract: BACKGROUND
  Since the introduction of vacuum-assisted closure (VAC) in 1997, it has been used successfully in treating difficult wounds, including spinal wounds and wounds in pediatric patients. There are no reports on VAC therapy in pediatric patients on the scalp, especially with exposed dura. This report describes a 10-year-old boy with a chronic wound of the scalp with exposed dura after multiple neurosurgical interventions who was treated successfully with VAC.
  
  
  METHODS
  A 10-year-old mentally disabled boy with Apert syndrome suffered from a chronic wound with community-associated methicillin-resistant Staphylococcus aureus (MRSA) infection after multiple neurosurgeon operations. For wound closure, VAC therapy was initiated on the bony defect with exposed dura. The wound healed successfully, and the MRSA disappeared.
  
  
  CONCLUSIONS
  The aims of VAC therapy are formation of new granulation tissue, wound cleansing, and bacterial clearance. In this case, the VAC device was excellent for temporary coverage of the defect and for wound cleaning, and it allowed a thick bed of granulation tissue to form over the dura, even with minimal constant negative pressure. The application and management were feasible even in a mentally disabled child. With this experience, we are encouraged to use the VAC device in difficult wounds, even in the head and neck area in children, and to bring this treatment into the outpatient clinic.
authors.affiliation: Pediatric Surgery, Children's Hospital, University Zurich, Zurich, Switzerland. subotic18@gmx.net
authors.forename: Ulrike
authors.initials: U
authors.lastname: Subotic
authors.forename: Wolfram
authors.initials: W
authors.lastname: Kluwe
authors.forename: Valérie
authors.initials: V
authors.lastname: Oesch
mesh_terms: D002648:Child; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000601:surgery; D004388:Dura Mater / Q000382:microbiology / Q000601:surgery*; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D012535:Scalp / Q000382:microbiology / Q000601:surgery*; D013207:Staphylococcal Skin Infections / Q000175:diagnosis / Q000601:surgery*; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000601:surgery*