Successful Combination of NPWT and a Fistula/Wound Manager to Contain and Promote Healing of Wounds with Non-pouchable High Output EC Fistulas

TOPIC: Management and promotion of wound healing in open abdominal wounds with enterocutaneous fistulas is extremely difficult when the fistula is located in an area which can not be isolated from the wound such as in a tunnel, undermining, close to the wound edge or in a crevice. Amount and varying degree of consistency of output can also challenge containment. Past management of these complex wounds has been attempted with NPWT(foam/gauze) or Wound/Fistula Managers. Containment of output by NPWT dressings often fail due to consistency of output clogging the foam and tubing or the amount simply overwhelming the dressing, thus contaminating the periwound skin. Wound/Fistula Managers may contain the drainage but allow it to remain on the wound, thus not promoting wound healing. OBJECTIVE: This poster will show an innovative combination of a Wound/Fistula Manager with adhesive window access and use of antimicrobial gauze packing with large fenestrated tubing connected to a NPWT device. Easy access to the wound allows for daily irrigation and change of gauze packing by the nursing staff. Drainage is collected in a cannister allowing important measurement of output. OUTCOMES: Three patients with non-pouchable high output fistulas in a LTAC facility were successfully treated with this type of management. Two patients had closure of the fistulas within a few weeks along with healing to the point that one was able to have further surgery for colon cancer and the other was able to go home on traditional NPWT with foam. The third patient, with a stomatized colocutaneous fistula in a deep wound located close to the wound edge, had healed to the point of STSG and further surgery. CONCLUSION: The combination of the positive aspects of two traditional treatments of wounds with fistulas enabled successful containment while also promoting granulation and healing of complex wounds.