Negative Pressure Wound Therapy for Fistula Management?

Abdominal wounds with fistulas present a challenge to patients, surgeons, and clinical staff even in an advanced practice setting with a multitude of treatment options.  This particular patient, a 72 year female, presented with a chronic abdominal abscess related to previous surgeries.  Her surgery in 2001 left her with two small, draining openings in her abdomen.  The patient managed these wounds with gauze packing and frequent dressing changes.  After five years, she came to this clinic looking for other options.  The patient was given three options, two of which involved surgery.  Due to her co-morbidities of insulin dependent diabetes, hypertension, renal insufficiency, and coronary artery disease, the patient opted against surgery. Her topical management was changed to an absorbent silver, and she was started on antibiotics.  After one year of topical and antibiotic management at home, the patient returned to the clinic with increased drainage, pain, and inflammation. At this point surgery was performed and a mass of bile and bowel content was removed.  The patient was left with a 5 x 13 x 3 cm wound which was draining stool. The nursing staff instructed the patient on the use of zinc-oxide paste and silversulfadiazine cream. Total parenteral nutrition and multiple pharmaceuticals were also ordered.  In the past Negative Pressure Wound Therapy (NPWT) wound have been initiated but was found to have its limitations with managing effluent.  However, an alternative NPWT was now on the market which offered various tube sizes with larger lumens. This new NPWT was initiated and over the course of three months the wound contracted, the drainage was managed, and the patient avoided further surgery.  Although this was a complex dressing, we found promise with the new NPWT for fistula management.