Use of Best Practice and Clinician Expertise to Successfully Manage Wounds Containing Fistulas - The Barnes-Jewish Hospital Experience

Negative Pressure Wound Therapy has become a common treatment modality for various types of wounds, (Hurd 2010). In our practice, we have utilized Negative Pressure Wound Therapy in the treatment of complex wounds containing fistulas. These wounds are very challenging and are frequently referred to our Medical Center due to failure of conventional treatments, as well as our history of success with these types of wounds and our use of Best Practice .These wounds are usually too large for existing pouching systems and thus require frequent, often painful, dressing changes.  These frequent dressing changes are also labor and cost intensive.

Negative Pressure Wound Therapy is not new and has been practiced in different forms since the early 1980’s. There is a need to expand the knowledge base, efficacy, and innovative applications even though there has been a plethora of Evidence Based Practice surrounding the use of Negative Pressure Wound Therapy.

We have applied this method of wound therapy to promote wound healing, reduce edema, increase blood flow to the wound, manage wound excudate, and ultimately control and contain fistula drainage.

In our procedure, we have adapted the gauzed-based Negative Pressure Wound Therapy* with a pouching system to isolate and contain the fistula drainage from the wound area. This approach has resulted in an increase in patient comfort, mobility, and self esteem due to a decrease in dressing changes and odor control. It has also established the preservation of periwound skin and allowed granulation.

 This unique procedure benefited the patient as well as the nurses by decreasing the amount of nursing time required and thus, increased staff satisfaction.   The family members and the physicians were also very appreciative of our efforts.