Originally, the application of the negative pressure device strictly followed manufacturer guidelines. Company representatives were present in the operating room for the damage control surgery. However, physicians reported that they were continuing to lose fascial domain even when NPWT was correctly applied. The WOCN team was asked to manage patients on the ward when domain was lost, intra-abdominal contents were locked in and there was no further indication to manage the patient in the operating room. Patients presented to the WOCN service with profound midline defects averaging more than 1000 cm2, all with exposed bowel.
The application technique used for the management of these patients involves two WOC nurses, a NPWT device for open abdomen and the surgeons. The nurses place a non-adherent layer into the gutters to protect exposed bowel. A duo of football-shaped and fish-shaped foam is used to prevent retraction of the fascia, decompress the bowel and keep skin margins mobile for eventual primary closure. Drape is used to pull the skin medially and the dressing itself is molded centrally as the suction is engaged. Additional pieces of full-thickness black foam can be used above the protective layer to further move the bowel into the abdomen. The entire visible dressing is at skin level.
The “fish” NPWT technique allows the WOCN to minimize the definitive closure for the patient by preserving fascial and skin mobility and moving the bowel back inside the abdominal wall. Together surgeons and WOC nurses are working for positive outcomes in this complex population.