Department of Surgery, University Hospital Regensburg, Regensburg, Germany.
Wounds. 2020 Dec;32(12):E62-E66.
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.
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.
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.
开放性腹部创伤伴有肠瘘形成是腹部外科的棘手并发症。特殊瘘管装置（SFD）与持续冲洗和驻留时间的负压伤口治疗（NPWTi-d）联合使用，可能改善这些伤口的管理，增加 NPWT 敷料的耐用性，并有助于减少敷料渗漏。
一位 57 岁肥胖女性（体重指数：55 kg/m²），患有克罗恩病和多次肠切除术，出现嵌顿性造口旁疝、脓肿形成和感染性休克。疝复位和感染控制后，进行了牛网状增强疝修补术。用于伤口闭合的皮肤旋转皮瓣发生坏死，导致感染性开放性腹部创伤，大小约 60 cm x 50 cm，另外形成 2 个小肠道瘘管，与造口相邻，伴有大量细菌和真菌感染。手术清创后，开始使用 NPWTi-d，持续 10 分钟浸泡生理盐水，然后进行 2 至 4 小时的-125 mmHg 负压治疗，联合使用 SFD；大约在启动后 3 周感染得到控制后，治疗方案切换为传统的 NPWT，使用-125 mmHg 持续负压和 SFD。按需更换敷料。在整个治疗期间，局部感染得到控制，伤口清洁，形成了厚厚的肉芽组织（甚至在网状物的暴露部分）。敷料的稳定性提供了高水平的患者舒适度。
NPWTi-d 联合 SFD 通过提供迅速的伤口清洁、消毒、局部感染控制和患者舒适度，以及帮助在生物网片上生成肉芽组织，为处理具有挑战性的瘘管性腹部创伤提供了一种可行的工具。
