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Introduction: Abdominal wounds with enterocutaneous fistulas present treatment challenges to patients, surgeons, and staff. The purpose of this abstract is to present alternative options of negative pressure wound therapy (NPWT) management system when dealing with an enterocutaneous fistula within an open complex abdominal wound.
Clinical Problem: To manage a complex abdominal wound of a 58-year-old patient while containing effluent from an enterocutaneous fistula. Patient history includes ventral hernias (with several repairs), asthma, HTN, DVT with IVC filter, GERD and NIDDM. The fascia was surgically closed using vicryl mesh. Clinicians were still challenged to close the resulting 51x53 cm open abdominal wound. The wound was complicated by the addition of stool contamination resulting from an enterocutaneous fistula located within the distal wound bed. Using a non-woven, polyester dressing* shows an innovative approach for containing fistula drainage in a wound managed with NPWT.
Clinical Approach: The abdominal wound was covered with a non-occlusive, fine polyester mesh**. The stomatized fistula was isolated by placing skin barrier rings and a non-adherent, non-woven polyester dressing placed around the fistula prior to application of NPWT. The fistula was pouched with an ostomy drainable pouch to contain fistula drainage. NPWT was maintained at 75 mmHg, promoting abdominal wound healing. Dressings were reduced as successful grafting was occurring.
Outcomes: A barrier seal was successfully maintained around the fistula, granulation tissue developed over the vicryl mesh and the grafts were successfully facilitated and protected. Patient comfort was facilitated by non-adherent, non-woven polyester dressings along with lower pressure. NPWT systems using lower pressure with dressings designed to reduce pain, bleeding and tissue disruption upon removal can be used successfully in complex abdominal wounds.
*Bio-Dome is a trademark of Boehringer Technologies, L.P.
**Restore is a trademark of Hollister Wound Care LLC
Clinical Problem: To manage a complex abdominal wound of a 58-year-old patient while containing effluent from an enterocutaneous fistula. Patient history includes ventral hernias (with several repairs), asthma, HTN, DVT with IVC filter, GERD and NIDDM. The fascia was surgically closed using vicryl mesh. Clinicians were still challenged to close the resulting 51x53 cm open abdominal wound. The wound was complicated by the addition of stool contamination resulting from an enterocutaneous fistula located within the distal wound bed. Using a non-woven, polyester dressing* shows an innovative approach for containing fistula drainage in a wound managed with NPWT.
Clinical Approach: The abdominal wound was covered with a non-occlusive, fine polyester mesh**. The stomatized fistula was isolated by placing skin barrier rings and a non-adherent, non-woven polyester dressing placed around the fistula prior to application of NPWT. The fistula was pouched with an ostomy drainable pouch to contain fistula drainage. NPWT was maintained at 75 mmHg, promoting abdominal wound healing. Dressings were reduced as successful grafting was occurring.
Outcomes: A barrier seal was successfully maintained around the fistula, granulation tissue developed over the vicryl mesh and the grafts were successfully facilitated and protected. Patient comfort was facilitated by non-adherent, non-woven polyester dressings along with lower pressure. NPWT systems using lower pressure with dressings designed to reduce pain, bleeding and tissue disruption upon removal can be used successfully in complex abdominal wounds.
*Bio-Dome is a trademark of Boehringer Technologies, L.P.
**Restore is a trademark of Hollister Wound Care LLC