Treatment of complex open abdominal wounds with exposed viscera using a specialized negative pressure device in the acute care setting

Complicated open abdominal compartments with exposed viscera, abdominal hypertension, and compartment syndrome in critically ill patients are challenging to Wound Ostomy Continence Nurse (WOCN) specialists.  Abdomens may be left open for multiple reasons which may include sepsis-contamination, pancreatitis, necrotizing fasciitis, peritonitis, intra-abdominal trauma, mesenteric ischemia, to decrease intra-abdominal pressure, and/or the possibility of further abdominal exploration.  Intensive management is required to avoid further complications.

Past wound management included wet-to-dry dressings changed two to three times daily with extensive Critical Care Unit (CCU) stays.   

Abdominal closure can now be facilitated by applying an Open Abdomen Negative Pressure Therapy System (OA-NPT) with dressings changed twice weekly allowing patients to be managed on a medical-surgical unit. 

Two complex cases are described.

Case 1.

 73-year-old female: diagnosis of inflammatory bowel disease, diverticulitis, and hypertension.   Several days post colectomy, perforation required a small bowel resection with ileostomy.  She developed sepsis and abdominal wound dehiscence requiring surgical debridement, washout, and abdomen left open.  Following a second surgical debridement and washout, OA-NPT was applied.  In one week, decrease in wound size and granulation tissue was seen.  By week four, the viscera were covered with viable tissue and patient was stable enough to be transferred to a rehabilitation center.

Case 2.

A 70 year old female: past medical history of Renal and Ovarian CA admitted for small bowel obstruction.   Exploratory laparotomy was performed with subsequent development of enterocutanous fistula and abdominal wall necrotizing fasciitis requiring extensive surgical debridement, washout, and ICU admission.  Further debridement and application of OA-NPT occurred one week later.  After four weeks of therapy, the patient underwent skin graft for final closure of the wound.

These complex wounds were treated successfully with OA-NPT.  The use of this special therapy resulted in decreased wound complications, CCU care, nursing time, and hospital length of stay.