Abdominal fistulae are the nightmare of every surgeon and nurse. This is always the time when the trumpet call to the WOC nurse is heralded. The caustic effluent is eminently dangerous to the skin. The challenge for management is monumental.

Case Study

A man, in his early sixties, was involved in an accident. Three abdominal fistulae developed within his extremely large abdominal wound. Pouching methods were ineffective. The Negative Pressure Wound Closure method was attempted using the fistulae protocol endorsed by the company. However, the therapy leaked within 24 hours. The skin damage could not be halted.

An Unusual Idea

As the WOC nurse was riding up on the elevator to the unit, the need for a new plan became evident. If only the drainage from the fistulae could be contained in a smaller area so the large abdominal wound could begin to heal. What was in the hands of the nurse but a big Styrofoam coffee cup? Why not use the cup to seal off the fistulae from the wound. But would the coffee cup cause pressure that would create another wound?

Adaptation of the Coffee Cup:

The coffee cup was cut midway to ensue that it encompassed the fistulae. Cohesive seal was placed on the end of the coffee cup, which was to be implanted onto the wound. Then the coffee cup was filled with white sponge and a suction disk was place in the coffee cup. The remaining wound, outside the fistulae, was dressed with black sponge and another suction disc was applied.

Result: The fistulae have not closed. However, the entire skin around the wound healed within 3 months.

Implications for Nursing: Creativity and imagination coupled with knowledge are the tools of the WOC nurse. What other household item will enhance Advanced Wound Healing!