Management of abdominal wounds in patient with low ability of healling

Man patient, 47 years old, suffering from Budd-Chiary syndrome (occlusion of liver venas), was operated because of perforation of sigma diverticel. He has got a contemporary sigmostoma. He was receiving anticoagulant therapy, therapy for manage ascites, pain reliefes. Soon problems begans: big amaount of ascites and need for abdominal punction.After a week he has had dehiscence of laparatomy and another operation, surgeon put on tampon stitchers and said there is no sign of any granulation because of years undergone Medrol therapy. We put abdominal belt on for support. Near laparatomy wound was stoma and skin ulcer near the stoma, and after a time ulcers under all tampon stitchers. We choose polyuretan foam to manage wounds and alginate and hidrocolid on ulcer near the stoma so we can put collecting system on.We find out the patient is colonized with MRSA also and he was put into isolation still in intensive care unite. After three weeks of second operation surgeon remove tampon stitchers and there were small dehiscences of skin again on some places.We looked at diferent stages of damage of the skin and lower layers all over the abdomen and making plan how to manage this and maintain mobility of the patient. There were to many wounds, not so deep - so we couldnt put the negative pressure system on. We choose caring with hydrogel and polyuretan foam, wearing abdominal belt for support and pay attention on food with lot of proteins.Patient could move out of intensive care in his own room and have more visitors and music he like very much. Thing were getting better and he went home seven weeks after operation and comunnity nurse get directions to take care of the patient. The content of the poster is in three chapters - after first operation, second operation and after we have removed tampon stitchers. There are pictures which can say a lot more then words.