Diverting The Flow and The Use of Negative Pressure Wound Therapy and A Silicone Device

A 49 year old female patient presented, October 2016 for total pelvic exoneration. She had a history of Stage IV ovarian cancer. A transverse loop colostomy and right lower quadrant urostomy were created. In November 2016,  wound dehiscence that engulfed the urostomy. In order to place a negative pressure dressing on the delayed healing abdominal wound the urostomy had to be isolated from the wound. By placing a silicone isolation device, surrounded by a barrier ring over the urostomy, the CWOCN was able to isolate the urostomy and place a negative pressure therapy dressing over the dehisced abdominal wound.

The patient was discharged with the silicone isolation device and negative pressure wound therapy. This allowed the patient to go home sooner than expected. Isolating the urostomy improved the patient’s quality of life, dressing changes were minimized.  She no longer required thirty plus dressing changes a day of multiple absorbent pads and tape which lead to medical adhesive related skin injury (MARSI). Her pain level improved dramatically.  The negative pressure dressing was set at 125mmHg continuous and only had to be changed three times a week. She was able to go home and go out into her community and not be embarrassed that she was wet or smelled of urine. It also allowed her to care for her small children at home.

The wound granulated in with the use of the silicone isolation device and negative pressure therapy so much so that the wound became shallow enough that it would not allow the use of the silicone isolation device. The patient is able to manage the wound with damp saline dressings, and cover the urostomy with a pull-up to keep her dry. There are still challenges, but the wound has contracted considerably.