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Case Study
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A displaced ventriculo-peritoneal shunt as the cause of a nonhealing wound Alice Rocke, MD, Donna Finnegan, PA-C A.D. is a 78-year-old woman who presented to the wound care center one year after spontaneously developing a non-healing abdominal wound.Three weeks prior to the onset of the wound, the patient underwent an exploratory laparotomy with small bowel resection for a small bowel obstruction. Her postop course was complicated by respiratory insufficiency but there were no intra-abdominal or incision complications. Staples were removed prior to discharge Three weeks after discharge, the patient developed a wound on the abdominal wall, 5 cm. to the right of the midline incision. The wound drained copious amounts of clear serous fluid. There were no associated symptoms. Past medical history is significant for a subarachnoid hemmorhage and placement of a ventriculo-peritoneal shunt 15 years earlier Work-up included a CT scan which did not show an enterocutaneous fistula. One week after her initial visit, the patient was taken to the operating room for wound exploration. A large wound in the subcutaneous fat was found; the end of a V-P shunt was lying in the apex of the wound. Neurosurgery was consulted; the V-P shunt removed and the patient went on to heal without difficulty Wound bed preperation is the standard of care and includes management of exudate, removing necrotic or fibrinous debris and eliminating or minimizing bioburden. However, despite appropriate cares, many wounds fail to heal. Foreign bodies, radiation injury, cancer, a well epithelialized sinus tract and copious drainage all prevent wound healing. Each of these needs to be eliminated as a potential cause of non-healing when preparing a wound bed. As demonstrated in this case, surgery is often needed to explore the wound to prepare a wound bed- in this case, to remove a foreign body- to facilitate wound healing. |
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