-Case Reports-

A Case of von Willebrand Disease Discovered during Treatment of a Sacral Pressure Ulcer

Masahiro Murakami^1,2, Sumiko Fukaya³, Masaichi Furuya⁴ and Hiko Hyakusoku¹

¹Department of Plastic, Reconstructive and Regenerative Surgery, Graduate School of Medicine, Nippon Medical School
²Department of Plastic and Reconstructive Surgery, Nippon Medical School Musashi Kosugi Hospital
³Department of Nursing, Chikusei City Hospital, Ibaraki
⁴Department of Surgery, Chikusei City Hospital, Ibaraki

A sacral pressure ulcer developed in a patient hospitalized for cerebral infarction. Each time necrotic tissue was debrided from the ulcer, pressure hemostasis was necessary to stop the bleeding. As treatment continued, the pressure required to stop the bleeding caused the ulcer to worsen, leading to a downward spiral in the patient's condition. While trying to determine the cause of this problem, we discovered that the patient had von Willebrand disease. Medication controlled the bleeding, and the pressure ulcer began to heal at the same time. It was clear to us that conservative treatment would lead to a complete cure but that the healing process would take a long time and require continued administration of an expensive drug. We decided, therefore, to close the wound with a fasciocutaneous flap so that the patient could be quickly transferred to a rehabilitation hospital. About 1 month after surgery, epithelialization was complete, we were able to discontinue medication, and the patient was discharged. This experience demonstrates the importance of determining the cause of any deviation from the normal course of healing in pressure ulcers. It also indicates that the use of fasciocutaneous flaps, which involve little intraoperative bleeding in short surgeries, is appropriate in cases like this one.

J Nippon Med Sch 2010; 77: 325-327

Keywords
pressure ulcer, von Willebrand disease, bleeding tendency, fasciocutaneous flap

Correspondence to
Masahiro Murakami, MD, Department of Plastic and Reconstructive Surgery, Nippon Medical School Musashi Kosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa 211-8533, Japan
masa2@nms.ac.jp

Received, June 28, 2010
Accepted, August 26, 2010