USE of Porcine URINARY BLADDER Matrix (UBM) IN A Dehisced Wound BETWEEN Stomas Promoted RAPID Healing Facilitating Routine Pouch Changes IN A Premature Neonate

PROBLEM: Maintaining pouch adherence over neonates’ stomas after laparotomy for Necrotizing Enterocolitis (NEC) challenges the NICU staff. The likelihood of achieving a seal decreases when the pouching surface is an open wound. In this situation, a five week old female, born at the gestational age of 29 weeks 4 days with a birth weight 690 gm., presented with a dehisced wound between the ileostomy and the mucus fistula following laparotomy. The dehisced abdominal wound measured 1.5 cm by 2.5 cm, approximately 20 percent of the total abdominal surface area. The goal to heal the wound as quickly as possible in order to provide a flat pouching surface led to a search for a dressing that promoted rapid wound healing. PAST MANAGEMENT: Previously similar wounds were managed with hydrofiber covered with hydrocolloid dressing or tape strips and pouch application. However, this often failed to contain effluent and resulted in skin irritation and wound contamination, necessitating daily or more frequent pouch and dressing changes. CURRENT APPROACH: Porcine UBM was selected because of its ability to promote healing, and its composition that contains collagen, elastin, glyscosamionglycans and other materials associated with natural wound healing. Wound treatment consisted of application of porcine UBM covered with a perforated silicone sheet which was cut to circumscribe the stoma, followed by the pouch application. The dressing was changed twice a week, except for one time when the dressing had to be changed one day ahead of schedule. OUTCOMES: Complete wound healing was achieved in two weeks of implementation of porcine UBM. Additionally, the perforated silicone sheet helped to increase pouch adherence over the open wound, decreasing the number of pouch changes. CONCLUSIONS: Rapid healing was achieved with the use of porcine UBM, allowing better pouch adhesion and increased wear time in this premature neonate.