How I Treat: Pemphigus Vulgaris Case Presentation

• 53-Year-old female
• No significant past medical history including no prior history of autoimmune disease
• The patient had suffered a 9-month history of worsening symptoms of severe cutaneous wounds and was experiencing severe pain
• On physical examination, the patient was found to have roughly 3000 cm² of blistering/open wounds to the back, posterior neck, both arms, both legs, chest and both breasts, estimated to cover ~30% TBSA (Figure 1)
• Initial blood work results were:
  • ESR 40 (H)
  • CRP 7.8 (H)
• Biopsy results confirmed the clinical suspicion of autoimmune disease, showing a positive result for Pemphigus Vulgaris (PV)

• The treatment plan was similar to that of a partial thickness burn:
  • Aggressive fluid replacement
  • Analgesia
  • Infection control
  • Surgical wound debridement
• At the first surgical procedure
  • All cutaneous wounds were debrided (Figure 2 and 3)
  • Myriad Matrix was applied to approximately 2000 cm² (2/3 of the wounds) and was sutured in place with absorbable suture
  • The patient was beginning to destabilize, so the remaining open wounds were treated with topical antibiotics and a non-adherent dressing.

• 1 Week. The graft was gentle debrided and revealed that the cutaneous wounds on the arms, abdomen and thighs had completely healed (Figures 4 and 5). The areas treated with topical antibiotic and a non-adherent dressing remained unchanged. Myriad Matrix was then applied to these remaining open wounds and dressed with a non-adherent followed by absorptive dressings.

• 1 month post-operative. All wounds were healed, apart from two small postage-stamp sized wounds on the buttocks (Figures 6 and 7).

• Coverage of the exposed wound base with Myriad Matrix helped reduce pain, decrease dressing changes, and therefore reduce patient discomfort compared to dressings requiring daily changes.
• Reduced nursing care due to weekly as opposed to daily dressing changes.

• This case report highlights the ability for Myriad Matrix to assist in the management of large TBSA wounds which can be difficult to manage both for patients and clinicians due to the post-operative pain control, frequent dressing changes and prolonged healing time
• Myriad Matrix presents opportunities for cost-savings in treating large TBSA wounds as it reduces professional time and resources at dressing changes.

Myriad Matrix™ is a trademark of Aroa Biosurgery Limited.

Dr. Kokal has a consultancy agreement with Aroa Biosurgery Limited.

January 2022 | MKT.1778.00