Shinohara Makoto, Yano Takuya, Shimomura Manabu, Okuda Hiroshi, Akabane Shintaro, Mochizuki Tetsuya, Oyama Hitomi, Ohdan Hideki
Department of Gastroenterology and Transplant Surgery, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan.
Department of Nursing, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.25-0241. Epub 2025 Aug 21.
Surgical site infection (SSI)-associated wound dehiscence offers management challenges, often requiring frequent and prolonged wound care to achieve healing. Dehiscence may result in evisceration, requiring careful attention to infection management and organ protection, leading to extended hospitalization, poor cosmesis, increased costs, and higher risks of incisional hernias, all of which reduce patient satisfaction. Herein, we outline 3 cases in which the combination of negative pressure wound therapy with instillation and dwell time (NPWTi-d) and deep cavity wound dressing and protective agent (Sorbact) enabled safe and early wound healing.
Case 1: A 76-year-old man underwent open ileocecal resection for bowel obstruction secondary to cecal cancer. On POD 3, an SSI was observed, and on POD 6, bowel evisceration resulting from wound dehiscence occurred, necessitating reoperation for suture closure. NPWTi-d was initiated 2 days after reoperation. On POD 9, extensive necrotic tissue was observed at the wound base, and Sorbact was applied while continuing NPWTi-d. On POD 34, favorable granulation tissue formation was noted, and skin closure was performed. Case 2: A 94-year-old man underwent a Hartmann procedure for a sigmoid colonic perforation. On POD 10, wound erythema and purulent discharge were noted, leading to wound opening. As a result, NPWTi-d was initiated. Partial fascial dehiscence with bowel exposure was observed on POD 19. Extensive necrotic tissue was present; thus, Sorbact was applied, and NPWTi-d was continued. On POD 38, granulation tissue formation was deemed favorable, and NPWT was discontinued. Case 3: A 77-year-old man underwent a Hartmann procedure for rectal cancer perforation. On POD 9, an SSI was noted, and wound irrigation was initiated. On POD 13, partial fascial dehiscence with bowel exposure was observed, with necrotic tissue at the wound base. Sorbact was applied, and NPWTi-d was initiated. Gradual granulation tissue formation was achieved, and NPWT was discontinued on POD 40, followed by skin closure.
Wound dehiscence resulting from SSI markedly impairs patients' quality of life and presents a major therapeutic challenge. The combination of NPWTi-d and Sorbact enabled safe and effective treatment for refractory wounds.
手术部位感染（SSI）相关的伤口裂开带来了管理挑战，通常需要频繁且长期的伤口护理才能实现愈合。伤口裂开可能导致脏器脱出，需要仔细关注感染管理和器官保护，这会导致住院时间延长、美容效果差、成本增加以及切口疝风险升高，所有这些都会降低患者满意度。在此，我们概述3例病例，其中负压伤口治疗联合滴注和停留时间（NPWTi-d）与深部腔隙伤口敷料及保护剂（Sorbact）的组合实现了安全且早期的伤口愈合。
病例1：一名76岁男性因盲肠癌继发肠梗阻接受了开放性回盲部切除术。术后第3天观察到手术部位感染，术后第6天因伤口裂开导致肠管脱出，需要再次手术进行缝合关闭。再次手术后2天开始使用NPWTi-d。术后第9天，在伤口底部观察到广泛的坏死组织，在继续使用NPWTi-d的同时应用了Sorbact。术后第34天，可见良好的肉芽组织形成，随后进行了皮肤缝合。病例2：一名94岁男性因乙状结肠穿孔接受了哈特曼手术。术后第10天，发现伤口红斑和脓性分泌物，导致伤口裂开。因此，开始使用NPWTi-d。术后第19天观察到部分筋膜裂开并伴有肠管外露。存在广泛的坏死组织；因此，应用了Sorbact，并继续使用NPWTi-d。术后第,38天，肉芽组织形成良好，停止使用负压伤口治疗（NPWT）。病例3：一名77岁男性因直肠癌穿孔接受了哈特曼手术。术后第9天，发现手术部位感染，开始进行伤口冲洗。术后第13天，观察到部分筋膜裂开并伴有肠管外露，伤口底部有坏死组织。应用了Sorbact，并开始使用NPWTi-d。逐渐实现了肉芽组织形成，术后第40天停止使用NPWT，随后进行了皮肤缝合。
SSI导致的伤口裂开显著损害患者生活质量，并带来重大治疗挑战。NPWTi-d与Sorbact的组合为难治性伤口提供了安全有效的治疗方法。
