Authors (including presenting author) :
Mak HN(1), Shit KYF(1), Tong SY(1), Lam MY(1), Yu HY(1), Leung YY(1), Cheung KWA(1), Chui ST(1)
Affiliation :
(1)Department of Surgery, Prince of Wales Hospital
Introduction :
Managing complicated wound is an utmost challenge when the integrity of wound bed is compromised by unfavorable conditions when enteric stoma, enterocutaneous fistula or any obscure underlying structure situates within the wound. Moreover, it is a dilemma when Negative Pressure Wound Therapy (NPWT) is deemed effective in promoting wound healing, but endanger non-intact wound bed. Here present 4 case reports demonstrating innovative wall building’s isolating techniques for multiple regimes applied in one complicated wound simultaneously. Since Nov 2020, NTEC Wound Services Team collaborated with ward nurses and surgeons from Department of Surgery, PWH had successfully managed four patients’ complex wound conditions: (Case 1) a fistulated laparotomy wound (adult); (Case 2) a stoma laid within an ileostomy closure wound (adult); (Case 3) a perianal-vaginal extended open wound (adult) and (Case 4) an open abdominal wound with fascial defect partially (paediatrics).
Objectives :
(1) To promote wound healing by special isolating technique – wall building in complex wounds; (2) To optimize wound condition to be manageable by ward nurses for wound dressing in ward settings; (3) To enhance inter-professional collaboration between surgeons, nursing staff and Wound Service Team in complex wound management.
Methodology :
In case 1 & 2, the high output stoma or fistula within the open wound were isolated by wall building with different skin barriers skilfully, then the entire abdominal wound was pouched with a wound manager and also allowed packing to the remaining wound simultaneously through pouch window. Ward nurses could perform wound care daily incessantly. In case 3, a high wall partition was built up between patient’s vaginal and perianal wound areas, so that half part of wound (perianal area) can be applied with NPWT successfully to remove profound exudate. Wound packing could be applied to another half part of wound (vaginal area). NPWT in half wound was impossible but possible finally. In paediatric case 4, barrier seal was created to separate the upper and lower of abdominal wound. Then, the upper half (with fascial defect) was managed by daily wound packing, where else the lower part (with intact wound bed) can be managed by NPWT. Different regimes applied in one wound was achieved.
Result & Outcome :
To develop innovative wall building’s isolating techniques for simultaneous application of multiple wound care regimes in one single complicated wound. In case 1, the technique successfully prevented fistula output from contaminating abdominal wound, so local inflammation decreased rapidly. Wound size decreased by 30% and slough decreased by 40% in 2 weeks. In case 2, wound size decreased by 10% and slough decreased by 20%, systemic infection subsided and contributed to favorable condition for re-operation (stoma closure) in 2 weeks. In case 3, the dehisced perianal part with NPWT successfully applied resulting in 100% red granulating tissue and reduced wound size by 15% after 1 week. Wound contraction was attained with vacuum environment by the half-portion NPWT. In case 4, the half-portion NPWT has sealed up effectively over lower part of wound resulting in dramatic 30% slough reduction. With 24-hours bacterial clearance by NPWT causing 30% reduction in overall wound size after initial application for 1 week. Multidisciplinary team approach with thoughtful skills helps impossible wound management regimes made possible.
