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Facing the Challenges of Managing a Large Abdominal Wound in a Complex Patient-the use of a Negative Pressure Wound System to Promote Wound Closure and Improve a Patients Quality of Life
Control of intra-abdominal fluid secretion, facilitation of abdominal exploration, and preservation of the fascia for abdominal wall closure is a major challenge in the management of patients with an open abdomen.
The open abdomen is associated with significant morbidity and mortality rates in excess of 25%. In addition, there are considerable socio-economic costs associated with prolonged hospital admission Therapeutic approaches are to initially control the wound, contain abdominal contents, prevent infection, and, sub-sequentially promote wound closure without hernia formation.
Our patient is a seventy year old male with a history of melena stools for one month. Co-morbidities include diabetes, hypertension, s/p CABG, vascular disease, and liver cirrhosis.
Our patient was taken urgently to the OR on 1/17/08 where an ileocecostomy ,exploratory laparatomy and repair of a perforated appendix were completed. Also found at this time were extensive small and large bowel pneumatosis {free air}
The abdomen was left open with the application a negative pressure therapy in the OR.
An ileostomy with a mucous fistula and vicryl mesh application to the abdominal wound was performed 1/20/08 .
Significant improvement to our patients quality of life was evidenced by exudate and pain management.
The negative pressure therapy system was utilized for ten months with dressing changes every three days. An aqueous wound gel and gauze dressing was utilized twice daily after the negative pressure therapy was discontinued. A very significant decrease in the size of the wound was evident along with abdominal closure.
Our patient, his wife, his physicians, and the nursing staff were appreciative and impressed with the progress of our patient.
Control of intra-abdominal fluid secretion, facilitation of abdominal exploration, and preservation of the fascia for abdominal wall closure is a major challenge in the management of patients with an open abdomen.
The open abdomen is associated with significant morbidity and mortality rates in excess of 25%. In addition, there are considerable socio-economic costs associated with prolonged hospital admission Therapeutic approaches are to initially control the wound, contain abdominal contents, prevent infection, and, sub-sequentially promote wound closure without hernia formation.
Our patient is a seventy year old male with a history of melena stools for one month. Co-morbidities include diabetes, hypertension, s/p CABG, vascular disease, and liver cirrhosis.
Our patient was taken urgently to the OR on 1/17/08 where an ileocecostomy ,exploratory laparatomy and repair of a perforated appendix were completed. Also found at this time were extensive small and large bowel pneumatosis {free air}
The abdomen was left open with the application a negative pressure therapy in the OR.
An ileostomy with a mucous fistula and vicryl mesh application to the abdominal wound was performed 1/20/08 .
Significant improvement to our patients quality of life was evidenced by exudate and pain management.
The negative pressure therapy system was utilized for ten months with dressing changes every three days. An aqueous wound gel and gauze dressing was utilized twice daily after the negative pressure therapy was discontinued. A very significant decrease in the size of the wound was evident along with abdominal closure.
Our patient, his wife, his physicians, and the nursing staff were appreciative and impressed with the progress of our patient.