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Case Study/Series
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Fistula Management with Negative Pressure Wound Therapy First Author: deLeon Jean Authors: Adora Lucius, RN, CWOCN, Melody Nagel, PT, Michelle Fudge, PT, Betty Garcia, tech, Tammy Chambers, PTA, Kristina Arredondo, PA Enterocutaneous fistulas within large post surgical abdominal wounds were successfully managed with the use of Negative Pressure Wound Therapy (NPWT). Four techniques were utilized to address stomatized and non-stomatized fistulas. The least complex technique involves direct placement of open-celled reticulated foam over the fistula opening. When the fistula has stomatized, a cone technique to invert the intestinal mucosa can be utilized before placement of the foam. When isolation of the fistula is needed, then crafting of a water tight seal around the fistula opening can be accomplished within a NPWT set up. Stacking of products designed to adhere and repel moisture can be varied for different settings. A similar technique can be utilized for fistulas or ostomies that are not flush with the base of the wound bed. The stacking of adhering moisture repellent products within a NPWT set up can be combined with bolstering techniques to level the orientation of the stoma. These four case studies reflect resolution of three enterocutaneous fistulas within large post surgical wounds and one successful resolution of a large peristomal wound resulting in a simple ileostomy pouching technique. |
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