PEDIATRIC S.O.S. (Save Our Skin) USING NEGATIVE PRESSURE WOUND THERAPY TO CONTROL JEJUNOSTOMY EFFLUENT

ABSTRACT:

Purpose:  The aim of this case study is to improve and maintain the skin integrity of a premature infant with a high output jejunostomy located in a deep skin fold.

Settings and Subject:  The study was conducted in a local children’s hospital over a ten month period. The subject was a premature female with NEC totalis; left with 2-3 cm of small bowel. Jejunostomy was high output (approx 500cc/24hr) with extensive peristomal denudation, in a deep abdominal fold.

Method:  Several pouching techniques were attempted, using various pediatric appliances without success. Pouching with a Repogle tube through the pouch to wall suction also failed; causing increased leakage and resulted in peristomal breakdown. Skin barrier over stoma powder to denuded skin, with absorptive dressings over stoma, were ineffective as well. Negative pressure wound therapy was initiated to control effluent and improve denuded peristomal skin.

Results:  Photographs taken during the time negative pressure therapy was in use show significant improvement in peristomal skin folds. Although not indicated for control of effluent, negative pressure wound therapy allowed skin to heal in preparation for takedown and eventual bowel transplant. Infant had significant decrease in pain as denuded skin improved.

Conclusion:  Negative pressure wound therapy may be an alternative method of treatment in difficult, high output ostomies in the pediatric population