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A Novel Approach to Managing a Fistula Within a Wound A fifty-year-old female was transferred to our medical center after experiencing wound dehiscence with fistula formation after extensive abdominal surgery with liver resection for a subcapsular hematoma. Our patient had no relevant co-morbidities.
A referral was made to the Wound/Ostomy team for assistance in managing a large transverse abdominal wound with a colocutaneous fistula draining liquid stool. The wound was too large for existing pouching systems. It was desirable to contain the fistula drainage for wound hygiene. Initial efforts were directed toward serial debridements, irrigation and drainage containment with negative pressure therapy. This process was briefly successful, however, the fistula drainage thickened and the negative pressure therapy was unable to handle the effluent.
The Wound/Ostomy nurses developed a novel method of cutting open cell foam to surround the fistula. Preparing the wound dressing in this unique manner provided a “platform” for an ostomy appliance which contained the fistula drainage. The combination of negative pressure therapy and the ostomy appliance allowed the fistula drainage to be contained, improving wound hygiene and promoting granulation tissue formation.
The wound was managed with negative pressure dressing changes every two days until the patient was ready for discharge approximately one month later.
After the negative pressure therapy system was discontinued, a calcium alginate dressing with transparent dressing cover was applied and was changed twice per day.
Our patient, her physicians, and the nursing staff were extremely pleased with this innovative wound/fistula treatment. The treatment addressed our patient’s quality of life issues, which included odor and drainage control, preservation of peri-wound skin, and increased self-esteem by allowing our patient to ambulate.
A referral was made to the Wound/Ostomy team for assistance in managing a large transverse abdominal wound with a colocutaneous fistula draining liquid stool. The wound was too large for existing pouching systems. It was desirable to contain the fistula drainage for wound hygiene. Initial efforts were directed toward serial debridements, irrigation and drainage containment with negative pressure therapy. This process was briefly successful, however, the fistula drainage thickened and the negative pressure therapy was unable to handle the effluent.
The Wound/Ostomy nurses developed a novel method of cutting open cell foam to surround the fistula. Preparing the wound dressing in this unique manner provided a “platform” for an ostomy appliance which contained the fistula drainage. The combination of negative pressure therapy and the ostomy appliance allowed the fistula drainage to be contained, improving wound hygiene and promoting granulation tissue formation.
The wound was managed with negative pressure dressing changes every two days until the patient was ready for discharge approximately one month later.
After the negative pressure therapy system was discontinued, a calcium alginate dressing with transparent dressing cover was applied and was changed twice per day.
Our patient, her physicians, and the nursing staff were extremely pleased with this innovative wound/fistula treatment. The treatment addressed our patient’s quality of life issues, which included odor and drainage control, preservation of peri-wound skin, and increased self-esteem by allowing our patient to ambulate.