Clinical Problem: 5/16/2006, 42 year old morbidly obese female with type II Diabetes, hypertension, Asthma and COPD had left ovary removed, a pelvic cyst and mass drained, and diverting colostomy. While hospitalized, she developed wound dehiscence and mucocutaneous separation. Her glucose levels were elevated above 400, and she was suffering with Asthma; therefore, physicians were adjusting her steroids.

Description of Past Management: 5/21/2006, a physician removed staples from the abdominal incision, leaving a wound measuring 9cm x 2.5cm x 7cm. Wet to dry dressings BID were ordered.

The patient's entire abdominal wound dehisced on 6/5/2006. The wound measured 18.5cm x 6.5cm x 13.5. Necrotic tissue was at wound bed, but the side walls were granulating. She also had mucocutaneous separation at right side of stoma. WOCN recommended Dakins 1/4 strength gauze BID, Calcium Alginate to mucocutaneous separation every two days. Patient was instructed to wear abdominal binder. The patient was discharged with home healthcare. She returned to the Emergency Department on 6/21/2006 with stool in the abdominal wound. The abdominal wound had purulent drainage and fibrinous tissue at wound bed. The colostomy had a complete mucocutaneous separation. A skin bridge separated the stoma from the wound. Stool was draining into the wound.

Clinical Approach: Silver NPWT dressing was implemented to reduce the bacteria bioburden in wound, to debride, promote granulation and provide a pouching surface at the colostomy. A nutritional assessment was completed. Glucerna BID was added, 500mg vitamin C, and a multiple vitamin with zinc q day was ordered.

Patient Outcome: The abdominal wound and mucocutaneous separation decreased in size and depth every dressing change. The NPWT was discontinued when the wound was 3cm deep. Calcium Alginate q day was implemented.

Conclusion: All treatment plans need to be monitored and re-evaluated by a multi-disciplinary team for optimal patient outcomes.