Problem: 61 y/o Hispanic female with colon cancer underwent diverting Ileostomy. Postoperatively, necrotic tissue extended medially from the stoma towards the abdominal incision. . On the second postoperative visit, patient was admitted for debridement resulting in a circumferential mucocutaneous separation. This separation communicated with the cavernous midline abdominal wound making a pouch application challenging. There was continuous effluent contamination of the wound and peristomal skin irritation.

Clinical Approach: Clinical issues: 1) lack of a pouching plane 2) open abdominal wound communicating with the stoma. Negative Pressure Wound Therapy (NPWT) was determined to be the best therapeutic treatment option. The challenge was twofold, obtaining a seal for effective NPWT and isolating the stoma output. The use of NPWT assisted in providing a pouching plane. To apply a pouch, the mucosal separation was filled with calcium alginate and covered with Stomahesive barrier. To ensure a seal between the calcium alginate filling the mucosal separation and the abdominal wound where the NPWT dressing would be placed, Stomahesive paste was inserted as a caulking to wall off and separate areas. This provided occlusion between the stoma and the wound allowing for a convex wafer with drainable pouch to be applied. Hyperbaric Oxygen Therapy began the fifth week. The patient was discharged and NPWT was discontinued. Hydrofiber dressing dressings were used at home.

Patient Outcomes: A pouching seal was maintained for three days and the abdominal wound contracted and granulated. Fifteen weeks post discharge, the patient's abdominal wound was healed except a tunneled area.

Conclusion: NPWT with traditional wound dressings and standard ostomy techniques allowed wound healing and stable peristomal plane for pouching.

Financial Assistance/Disclosure: No financial support was received for this study.