Complex Abdominal Wounds

Complex abdominal wounds are a challenging part of the WOCN’s role. At our large teaching hospital we practice evidence based care. These case studies examine patients with unique wounds that were effectively yet differently managed using modes of NPWT. Outcomes include wound healing, drainage containment, preservation and restoration of periwound skin, ease of patient care and improved quality of life. Digital wound photos will be included.

Mrs. W, 63 y.o., self referred December 2009.

• S/P hernia repair w/ mesh placement at OSH, resulting large abdominal wound.

• History: multiple abd surgeries for hernia repairs, HTN, obesity.
• Admitted w/ infected mesh, large amount foul smelling exudate.
• Odor and drainage containment priorities as well as wound healing.
• NPWT device w/ gauze based dressing selected for lower settings (60mm Hg), contact layer used over unstable abdominal fascia and exposed mesh.
• Wound essentially healed in May 2009.
• Successful repair of hernia, removal of infected mesh, bilateral lateral myocutaneous fascial releases 6/22/10.
• Weight loss was essential for success of surgery but needed balance for optimal nutrition for healing.
• Success includes healed wound and surgical repair, healthier patient due to improved nutrition, weight loss and regular exercise.

Mrs. U, 64 y.o., referred from out of state hospital 5/27/10 due to inability to manage her complex care.

• Presented with multiple, large wounds, multiple fistulas, malnourished, bed bound.
• Hx necrotizing pancreatitis, DM, HTN, hyperlipidemia.
• Admitting labs: protein 5.6, albumin 1.6, pre-albumin 9.
• NPWT device with foam based dressing @ setting 125mm Hg selected for aggressive wound care, desire for quick granulation and contraction.
• Fistula and stomas contained in wound manager pouch.
• TPN as well as oral supplements initiated.
• Successful takedown of ileostomy, mucous fistula and enterocutaneous fistula, repair of abdominal wall defect using biologic mesh 8/2/10.
• Surgical site healed successfully, pt ambulatory & returned home.