| 113 |
Informational/Educational Report
|
Negative pressure therapy in the management of postsurgical wounds complicated by enterocutaneous fistulae in morbidly obese patients Jean deLeon, MD, Melody Nagel, PT, Michelle Fudge, PT, Adora Lucius, CWOCN, Nancy Sweeney May, WOCN Morbidly obese patients sometimes undergo complex abdominal surgical procedures which can be followed by development of enterocutaneous fistulae. A review of literature shows many approaches to medical and surgical interventions for definitive treatment of enterocutaneous fistulae (ECF), but wound and effluent/output/drainage management must be effective to prevent further complications, and this is a challenge to clinicians. Conventional treatment of ECF includes adequate nutrition, perifistular skin protection, and containment of effluent. Negative Pressure Wound Therapy (NPWT) is a therapeutic element which can be adapted to the needs of individual patients based on prognostic indices, nutritional status, activity level, and body habitus Any patient with an unexpected post-surgical complication such as a draining fistula is faced with a devastating insult to psychological and physical well-being. Statistics show very high morbidity and mortality with enterocutaneous fistulae, as well as very costly hospital and outpatient courses of treatment, therefore a multifaceted approach which includes NPWT in promoting patients' physical and psychological well-being can be utilized to effect an earlier return to optimized level of function. .In our practice, we utilized three different non-traditional VAC techniques for three different patients, including gauze wick and black foam applied directly over non-stomatized fistula at wound base to promote new tissue formation; gauze wick, silicone non-contact layer and black foam over post-surgical wound to facilitate wound contraction and containment of effluent; and VAC framing to stabilize abdominal wall and facilitate wound contraction so that appropriate pouching appliances could be utilized for effluent containment when closure was not a feasible goal. |
|