Complex Wound Management

Complex wounds are a challenging part of the WOC nurses’s role. These case studies examine  large, unique wounds that were effectively managed by the WOC nurse using modes of NPWT while isolating enteric fistulas. Outcomes include wound healing, drainage containment, preservation and restoration of periwound skin, and expedited preparation for skin grafting. Digital wound photos will be included.

75 year old, Admitted 3/24/16 entero atmospheric fistula s/p ventral hernia repair for incarcerated small bowel 3/14/16. History: surgical repair of hip fracture 3/11/16, rheumatoid arthritis, morbid obesity, ventral hernia with multiple past repairs. Abdominal wound treated with negative pressure wound therapy (NPWT) isolating the fistula using the technique of wrapping a circle of dressing foam in the drape,surrounding the fistula, sealing with barrier rings.  NPWT continued until the wound ready for split thickness skin graft, NPWT continued on graft until epithelialization. Finally a fistula pouch used, discharged to rehab 5/25/16.

    40 year old, surgery 5/2/16 for penetrating pancreatic injury (stab wound), complicated by formation of enteric fistula. Wound treated with multiple modalities. NPWT was utilized and the fistula was isolated using a ring of foam, while other wounds were dressed on abdomen simultaneously (including pouching leaking feeding tube). A fistula pouch with access window, wound packing, attached to low wall suction was also used. Patient was discharged to LTAC  6/23/16 with a wound care plan. Patient had surgery 10/12/16 for fistula repair.  

    72 year old, history:CAD s/p MI, ischemic cardiomyopathy,COPD, Crohns disease, colectomy.  Surgery 8/26/16 for adnexal mass, complicated by enterotomy requiring small bowel resection, and reanastomosis. Course complicated by intraabdominal sepsis requiring multiple surgeries. WOC nurse consulted on 9/1/16 for an enteroatmospheric fistula within the wound.  NPWT was utilized for this large wound while isolating the multiple fistulas within the wound.  Transferred to LTAC  with detailed instructions for wound care.