Background: Morbidly obese patient, s/p total abdominal colectomy for treatment of long history of diverticular disease, develops wound dehisence with enterocutaneous fistulae two weeks post-surgery. Multiple trials with wound drainage collection devices failed to manage fecal effluent and/or close abdominal wound. Extensive periwound irriation developed due to continuous spillage of fecal effluent onto the skin as well as repeated application/removal of various appliances.

What Was Done: VAC (Vacuum-assisted Closure) Therapy used to assist with closure/ contracture of abdominal wound but, as the fistulae of the small bowel was exposed, diversion of the fecal stream with protection of this organ was needed. This diversion was done with use of a nasal trumpet connected to a urinary drainage bag while using VAC therapy to assist with closure of the abdominal wound. This dressing was initially changed by the unit Clinical Nurse Specialist & the WOC Nurse Practitioner. However, all RN staff were eventually taught to do this complex dressing to allow for 24 hr. management of this patient. Care of this patient also involved several disciplines including nutritional services, physical therapy, and psychiatry. Patient was placed on a specialty bed to prevent skin breakdown and allow for easier egress as well as participation in physical therapy to prevent deconditioning due to lengthy hospitalization.

Results: Healing of periwound skin, contracture of wound (poster has serial pictures), but patient required further surgery to close fistulae and allow for eventual discharge. Successful use of VAC therapy also made patient more comfortable and better able to sleep as the effluent was contained.