NPWT To A Complex Perirectal Wound: A Unique Management Approach

Negative pressure wound therapy (NPWT) is the gold standard for the management and closure of large open wounds of all types.  The challenge comes when the wound lies in the perirectal area of a morbidly obese patient.  This case study highlights the collaborative efforts of the inpatient CWOCN and home CWOCN in the management of a complex perirectal wound utilizing NPWT. 

• 49 y/o male with a history of morbid obesity and newly diagnosed diabetes mellitus type II (Hgb A1c = 10.7 upon admission). 
• 03/30/11 - patient presented from an outside hospital with a large (16cm x 4cm x 7cm with deep tunneling), complex perirectal horseshoe abscess requiring multiple surgical debridements. 
• 04/06/11 – Unsure of the possibility of applying NPWT to a complex wound in a challenging location, the surgical team sought the guidance and expertise from the CWOCN. A NPWT dressing was successfully placed to the site with the help of four people.
• By discharge, the dressing was applied with only the patient’s nurse and CWOCN.  Discharge to a rehab facility was discussed, but the patient refused and discharge to home with a VNA was coordinated.
• In an effort to create a seamless transition to home, the patient was sent with step-by-step instructions with digital photos (to be included on poster) to guide the visiting nurse through dressing changes.  The home CWOCN was notified of the patient’s case.
• Over the course of 13 weeks, there was frequent communication between the inpatient CWOCN and home CWOCN.  The pt presented to clinic for wound evaluations every 2 weeks. 
• 05/22/11 - wound was nearly healed with two small open areas remaining.  NPWT therapy was discontinued, and the pt was started on a silver hydrofiber dressing.
• 06/28/11 – patient presented to clinic with a fully healed wound.