The WOCN Society 40th Annual Conference (June 21-25th, 2008)


2214

Closure of dehisced myelomeningocele wound using extracellular wound matrix and negative pressure wound therapy in a neonate

Patricia Corvino, MSN, RN, CWOCN, Broward General Medical Center, Clinical Specialist, 1600 S. Andrews Ave., Ft. Lauderdale, FL 33316 and Tracey H. Stokes, MD, Broward General Medical Center, Plastic Surgeon, 1600 S. Andrews Ave, Fort Lauderdale, FL 33316.

BACKGROUND:  In order to provide the best care possible for our patients, WOCNsoften need to “think outside of the box” while at the same time basing our decisions on scientific-based research. Although studies have been conducted using negative pressure wound therapy (NPWT) in conjunction with tissue engineered products to facilitate wound healing, no literature is available regarding the use of this combined treatment in neonates. This study describes the use of NPWT and an extracellular wound matrix in the treatment of a myelomeningocele defect in a neonate. CASE STUDY: A male infant underwent closure of a myelomeningocele and VP shunt on the day of birth. The initial skin closure broke down, necessitating a fasciocutaneous flap at 3 weeks of age. Dehiscence was noted on post-op day 3 after the infant had suffered a respiratory arrest requiring resuscitation and reintubation. INOVATIVE CLINICAL MANAGEMENT: The decision was made to begin treatment of the open lumbar wound with NPWT using a silver foam dressing, with continuous suction at 50 mm Hg. Because of the infant’s small size and weight, the therapy was closely monitored. Once infection was controlled, an extracellular wound matrix was added in conjunction with NWPT to further promote wound healing. PATIENT OUTCOME: After 3 weeks of treatment with the combined therapies, the wound was fully granulated and re-epithelializing from the wound edges. The infant was discharged home with his parents at this point. Complete re-epithelialization was achieved by post-op week 7. CONCLUSION: The use of an extracellular wound matrix in conjunction with NPWT in a neonate promoted new tissue growth and ultimate wound closure via secondary intention, thereby avoiding the need for further surgery.

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