Open abdominal
wounds with
intestinal fistula formation are challenging complications in abdominal surgery. Special
fistula devices (SFD) used along with
negative pressure wound therapy with instillation and dwell time (NPWTi-d), may improve management of these
wounds, increasing NPWT dressing durability and helping decrease dressing leakage.
CASE REPORT: A 57-year-old, obese (body mass index: 55 kg/m²) female with a long history of
Crohn disease and multiple intestinal resections, presented with an incarcerated parastomal
hernia,
abscess formation, and
septic shock. After the
hernia was repositioned and the
infection controlled, a bovine mesh-augmented
hernia repair was performed. Skin rotation flaps for
wound closure became necrotic and led to an infected, open abdominal
wound measuring about 60 cm
x 50 cm with formation of 2 additional small bowel
fistulas alongside the
ostomy and a massive bacterial and fungal
superinfection. After surgical
debridement, NPWTi-d with 10 minutes soaking time with isotonic
saline solution followed by 2 to 4 hours negative pressure
therapy with -125 mm Hg combined with SFDs was initiated; once the
infection was controlled approximately 3 weeks after initiation, treatment was switched to traditional NPWT with -125 mm Hg continuous negative pressure and SFDs. Dressings were changed on demand. During the whole treatment period, local
infection was brought under control, the
wound was clean, and thick granulation tissue formed (even on exposed parts of the mesh). The dressing stability provided a high level of patient comfort.
CONCLUSIONS: By providing expedient
wound cleaning, decontamination, local infection control, and patient comfort, as well as helping generate granulation tissue even on biological mesh, NPWTi-d used with SFDs represents a viable tool for the management of challenging fistulizing abdominal
wounds.