Dr Alicia Miers1,2,3, Ms Kristen Storey1,2,3, Professor Roy Kimble1,2,3,4
1Queensland Children’s Hospital, South Brisbane, Australia, 2University of Queensland, St Lucia, Australia, 3Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, Brisbane, Australia, 4Queensland University of Technology, Brisbane, Australia
Ataxia telangiectasia is a neurocutaneous syndrome characterised by faulty DNA damage repair. Cutaneous granulomas are a common presenting feature and require long term wound management in parallel with systemic immunotherapy (Privette st al. 2014).
This is a case report of the recent use of the MolecuLight and Biodegradable Temporising Matrix (BTM) in the management of lower limb ulcerating granulomatous skin changes complicated by pseudomonas infection in a 15 year old with ataxia telangiectasia.
Management of this patient’s granulomatous lesions over the last 12 months has included; twice weekly dressings, steroid injections, acetic acid washes, gentamicin washes, and most recently targeted cleaning and debridement with the help of the MolecuLight followed by operative debridement and application of BTM.
The MolecuLight is a point of care technology that uses bacterial fluorescence imaging to help nursing and medical team members identify bacterial contamination that facilitated targeted intervention including wound swabs and debridement (DaCosta et al. 2015). Novosorb™ Biodegradable Temporising Matrix (BTM) is a fully synthetic dermal scaffold for tissue repair, and contributes to stable, durable and flexible wound closure (Cheshire et al. 2016).
Together, these technologies have transformed the wound care management for this patient, including the reduced requirement for analgesia, sedation or anaesthetic for acetic acid washes. The wound care for this patient is ongoing and we hope to share our local experience of the management of this rare paediatric condition.
Privette, ED, Ram, G, Treat, JR, Yan, AC & Heimall, JR 2014, ‘Healing of Granulomatous Skin Changes in Ataxia‐Telangiectasia After Treatment with Intravenous Immunoglobulin and Topical Mometasone 0.1% Ointment’, Pediatric Dermatology, vol. 31, no. 6, pp. 703-7.
DaCosta, RS, Kulbatski, I, Lindvere-Teene, L, Starr, D, Blackmore, K, Silver, JI, Opoku, J, Wu, YC, Medeiros, PJ, Xu, W, Xu, L, Wilson, BC, Rosen, C & Linden, R 2015, ‘Point-of-Care Autofluorescence Imaging for Real-Time Sampling and Treatment Guidance of Bioburden in Chronic Wounds: First-in-Human Results’, PLoS ONE, vol. 10, no. 3.
Cheshire, PA, Herson, MR, Cleland, H & Akbarzadeh, S 2016, Artificial dermal templates: A comparative study of NovoSorb™ Biodegradable Temporising Matrix (BTM) and Integra ® Dermal Regeneration Template (DRT), 03054179.
Dr Alicia Miers is a Registrar with the Paediatric Surgery, Urology, Burns and Trauma Unit at Queensland Children’s Hospital.