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August 2005

Dehisced Wound in a Heart Transplant Recipient—Quiz Case

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Arch Dermatol. 2005;141(8):1035-1040. doi:10.1001/archderm.141.8.1035-d

A 69-year-old man who had undergone orthotopic heart transplantation for ischemic cardiomyopathy presented with a poorly healing wound in the left side of his groin. When his chest was opened during surgery, an injury to a previously placed saphenous vein graft occurred, which required emergent cutdown and cannulation of his left femoral artery and vein and rapid initiation of cardiopulmonary bypass. His postoperative course was complicated by cardiogenic shock, renal failure, pericardial tamponade, and quadriplegia, which developed after a spinal infarct. Prednisone, cyclosporine, and mycophenolate mofetil therapy was initiated for immunosuppression. Infectious complications included Pantoea agglomerans sepsis and nosocomial pneumonia. Despite treatment with broad-spectrum antibiotics, the patient remained febrile and hypotensive. On postoperative day 30, the dermatology consultation service was asked to evaluate a wound in the left side of his groin. The femoral cannulation site, which had been closed surgically after the transplant procedure, dehisced 6 days before the dermatology consultation.

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