Problem: A 39 year old female with a BMI of 50 presented with a draining abdominal incision. A composite mesh repaired a ventral hernia one month prior. Risks included low hemoglobin and albumen, positive culture for mixed organisms including MRSA,and smoking 2-3 packs per day.

Past Management: After two weeks of IVAB and Dakins dressings, the infected mesh was removed revealing a 25 cm. fascial defect. A porcine submucosal small intestinal wound matrix¹ was sutured to the open fascial edges. A nonadherent interface² was placed and the wound was secured by negative pressure therapy³.

Management: Multivitamins, Vitamin C, iron, and a cystine-rich protein supplement⁴ were initiated. The non-adherent interface seemed to increase moisture at the matrix. Therefore,a petroleum free,veil-like interface⁵ was substituted with improved results (less moisture and more granular budding thru the fenestrated matrix). Within two weeks of antibiotic completion, a foul odor was noticed from the wound's biofilm-type slime. An oral anti-infective drug and topical silver gel⁶ was added under the negative pressure sponge. Gradually, the odor and cultured organisms diminished as the wound improved.

Outcome: Since wound healing is not stagnant,utilization of multiple wound care modalities is frequently needed to reach a positive outcome.This study, with pictorial series, will demonstrate one such symphony of product use which for this patient has been effective. Seven weeks post-op she was discharged home with a portable negative pressure unit. She wishes no nicotine patch and now smokes only 2-3 cigarettes per day. Her weight decreased from 150 to 134 Kg. Labs improved to normal limits. Healing is still in progress and will be followed.

¹ Surgisis wound matrix, Cook Urological Inc,Spencer, IN

² Non-adhering Dressing, Kendall,Mansfield,MA

³ V.A.C. (Vacuum-assisted Closure), KCI, San Antonio, TX

⁴ ProNutra, NuMedTec, Carson City,NV

⁵ N-TERFACE, Winfield Laboratories,Inc. Richardson,TX

⁶ SilvaSorb Gel, Medline Industries, Mundelein,IL