Comprehensive Management of Delayed Pediatric Nail Puncture Injury Complicated by Severe Soft-Tissue Infection: The Adjunctive Role of Negative Pressure Wound Therapy

Background: Puncture wounds in children are frequently underestimated, particularly when presentation is delayed or the initial injury goes unnoticed. Retained foreign bodies substantially increase the risk of deep soft-tissue infection, abscess formation, septic arthritis, and osteomyelitis. Prompt diagnosis and appropriate surgical management are essential to prevent serious complications.

Case presentation: A 4-year-old child presented with a 10-day history of progressive pain, swelling, erythema, and purulent discharge of the right foot following a nail puncture injury. Clinical and radiological evaluation revealed extensive soft-tissue infection associated with retained foreign material. Following aggressive surgical debridement, foreign-body removal, and irrigation, empirical intravenous antimicrobial therapy was initiated and subsequently guided by microbiological culture results. Negative pressure wound therapy (NPWT) using a vacuum-assisted closure (VAC) system was applied for three weeks. At one-month follow-up after completion of NPWT, the wound demonstrated complete coverage with healthy granulation tissue, marked reduction in wound size and depth, resolution of infection, and satisfactory functional recovery without the need for further surgical intervention.

Conclusion: This case highlights the importance of early recognition and comprehensive management of delayed pediatric puncture wounds. Combined surgical debridement, appropriate antimicrobial therapy, and adjunctive NPWT can effectively control infection, promote wound healing, and facilitate successful limb preservation in complex pediatric soft-tissue injuries.