Use of Negative Pressure Wound Therapy in Selected Cases to Facilitate Abdominal Wound Healing

BACKGROUND: Surgical wound dehiscence resulting in exposed bowel increases the risk for development of an enterocutaneous fistula. Consequently, management of exposed bowel in an open wound presents challenges in terms of wound care management. In addition, a surgical wound dehiscence within the peristomal plane of an ileal conduit also creates a complex challenge of maintaining an ostomy pouching system seal. CASES: Case 1 was a patient with peristomal skin complications requiring stoma re-siting and subsequent surgical wound dehiscence at the prior ostomy site. As a result, we addressed wound management in the setting of urinary leakage from the ileal conduit. We used negative pressure wound therapy (NPWT) in the setting of a peristomal dehisced surgical wound to promote healing and optimize peristomal skin health. Case 2 was a patient with an infected surgical incision requiring readmission to hospital and additional surgery. Intra-operative findings revealed a fascial defect with exposed bowel in the wound resulting in unique challenges for wound management. Again, we used NPWT in the setting of exposed bowel to promote granulation and achieve wound closure. CONCLUSION: Research regarding ideal wound management for complex open abdominal wounds with exposed bowel is sparse. These case studies summarize our clinical experience managing complex patients with wound dehiscence and abdominal fascia defects and risk of enterocutaneous fistula formation with NPWT.