Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Perioperative pressure ulcer prevention and skin protection strategies in a patient with epidermolysis bullosa undergoing long-duration surgery

  • Asami Ishii (Department of Dental Anesthesiology, Graduate School of Medical and Dental Science, Institute of Science Tokyo) ;
  • Takaya Ito (Department of Dental Anesthesiology, Graduate School of Medical and Dental Science, Institute of Science Tokyo) ;
  • Miki Yokoyama (Department of Dental Anesthesiology, Graduate School of Medical and Dental Science, Institute of Science Tokyo) ;
  • Mana Nakamura (Department of Dental Anesthesiology, Graduate School of Medical and Dental Science, Institute of Science Tokyo) ;
  • Kouichi Sugita (Department of Dental Anesthesiology, Graduate School of Medical and Dental Science, Institute of Science Tokyo) ;
  • Sayaka Asano (Department of Dental Anesthesiology, Graduate School of Medical and Dental Science, Institute of Science Tokyo) ;
  • Aki Kawauchi (Department of Dental Anesthesiology, Graduate School of Medical and Dental Science, Institute of Science Tokyo) ;
  • Shigeru Maeda (Department of Dental Anesthesiology, Graduate School of Medical and Dental Science, Institute of Science Tokyo)
  • Received : 2025.12.11
  • Accepted : 2026.02.27
  • Published : 2026.04.01
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Abstract

Dominant dystrophic epidermolysis bullosa (DDEB) is a rare inherited skin disorder characterized by extreme fragility of the skin and mucosa that poses significant challenges for anesthetic management. Herein, we report a case of a 65-year-old woman with DDEB who underwent a 13-hour surgery for mandibular cancer under general anesthesia. To prevent skin and mucosal injuries, meticulous perioperative strategies were implemented, including the use of barrier films and pressure-relieving pads and avoiding adhesive devices. High-flow nasal cannula oxygenation enabled awake fiberoptic intubation without the need for mask ventilation, minimizing the risk of blister formation and airway trauma. Despite the prolonged duration, no pressure ulcers or new skin injuries developed, other than minor epidermal peeling of the lips. This case demonstrates that comprehensive preoperative planning and intraoperative protection can ensure safe anesthesia in patients with DDEB undergoing long surgical procedures.

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References

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