Negative Pressure Wound Therapy for Patients With Complex Abdominal Wounds

Zhi Wang, MD; Ming Bai, MD; Xiao Long, MD; Ru Zhao, MD; Xiaojun Wang, MD

Disclosures

Wounds. 2017;29(7):202-208. 

In This Article

Abstract and Introduction

Abstract

The combination of open abdominal wounds and intra-abdominal infections is challenging to treat and often results in critical illness associated with high mortality.

Objective. The aim of this study is to evaluate the feasibility of using negative pressure wound therapy (NPWT) to manage complex abdominal wounds and summarize relevant treatment experiences.

Materials and Methods. A retrospective analysis of records from April 2012 to May 2015 identified 13 hospitalized patients with open abdominal wounds complicated by intra-abdominal infections. Patients received systemic antibiotics. Negative pressure wound therapy was applied at the bedside if prior debridement or decompression and drainage via laparotomy did not yield positive results or if the patient could not undergo surgery.

Results. Of the 13 patients who were included in the study, 10 achieved wound closure (range, 19–52 days; median, 26 days). Among the 3 patients who did not achieve closure, 1 requested transfer to a hospital in his hometown, 1 developed an intestinal fistula that required surgery, and 1 died of a digestive tract hemorrhage unrelated to NPWT.

Conclusions. By providing sufficient drainage, NPWT effectively removed wound fluid and infectious material. The reduced edema helped lower intra-abdominal pressure, reduce the risk of abdominal compartment syndrome and infection, and improve patient prognosis.

Introduction

After years of development and improvement, negative pressure wound therapy (NPWT) has become a milestone in wound treatment. Contraindications for use in the treatment of acute and chronic wounds specify that NPWT should not be applied to an infected wound that has not been radically debrided, and foam dressings used with NPWT should not be placed in direct contact with exposed abdominal viscera, other organs, blood vessels, anastomotic sites, or nerves.[1]

Open abdominal trauma leads to intra-abdominal infections in a cause-and-effect relationship. When treating patients with open abdominal wounds complicated by intra-abdominal infections, surgery does not always guarantee effective debridement and drainage. Repeated surgery also has some risks. If increased intra-abdominal pressure (IAP) is not identified and managed effectively in trauma patients, especially those with an abdominal injury, intra-abdominal hypertension can develop and rapidly deteriorate into abdominal compartment syndrome (ACS), which is quite difficult to handle and indicates a poor patient prognosis.[2,3]

A retrospective record review was conducted to evaluate the use of NPWT to treat patients with abdominal wounds complicated with intra-abdominal infections.

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