Rare Operative Intervention for Urinary and Fecal Incontinence-Associated Dermatitis

Samantha Delapena, MD; Philomene Spadafore, RN, MHA; Stephanie E. Bollenbach, MD; Areta Kowal-Vern, MD; Kevin N. Foster, MD, MBA, FACS; Marc R. Matthews, MD, FASC

Disclosures

Wounds. 2021;33(4):E31-E33. 

In This Article

Case Reports

Case 1

After being shuffled between several local emergency departments, a 65-year-old male was transferred to the authors' emergency room. Bedridden without a caregiver for 1 week, he was found lying in urine and feces. The patient had 14 % total body surface area (TBSA) superficial to deep PT burn-like injuries from an unknown mechanism to the back, bilateral buttocks, posterolateral lower extremities, and perineum (Figure 1). There was no antecedent history involving scald or thermal burn injuries. Past medical history revealed alcohol misuse with alcoholic cirrhosis, chronic arthritis, type II diabetes with retinopathy, hypertension, cardiomyopathy, and depression. The patient underwent operative debridement using curettage to remove any burn-like eschar, and the wounds were dressed with a silver-impregnated foam dressing (Mepilex Ag; Mölnlycke Health Care). On postoperative day 1, treatment transitioned to MediHoney Gel (Integra LifeSciences).

Figure 1.

Case 1: patient wounds of left lateral thigh, bilateral buttocks, and lower back at (A) hospital day 2; (B) postoperative day 8 after debridement with curettage; and (C) postoperative day 18 at clinic follow-up appointment.

The patient received tube feedings and intravenous fluid of half normal saline for the oliguria. Hyperglycemia was treated with subcutaneous insulin. To avoid urine and fecal contamination of the wounds, a Foley catheter and fecal management system were placed. On hospital day 12, the patient was discharged to a skilled nursing facility.

Case 2

An 85-year-old female presented with a 4% TBSA chemical burn to the left torso, flank, and thigh (Figure 2). After falling at home, the patient was unable to move, so she had laid in her urine and feces for an unknown length of time; the patient was found after neighbors requested a welfare check. A syncopal workup was negative; the patient had a urinary tract infection on admission. Comorbidities included Alzheimer's disease and depression. After a 12-day hospitalization following debridement with curettage and silver-impregnated foam dressings, the patient was discharged to a psychiatric facility for treatment of the Alzheimer's disease and depression.

Figure 2.

Case 2: patient left flank wound at (A) admission; (B) postoperative day 12 after debridement with curettage; and (C) postoperative day 24 at clinic follow-up appointment.

The patient was readmitted to the authors' hospital 11 days later for operative management due to full-thickness conversion of the wounds, which required surgical excision. Urinary urgency and incontinence were present, necessitating vigorous toilet training. The patient underwent tangential excisional debridement and fascial excision with porcine xenograft placement (EZ Derm; Mölnlycke Health Care); 3 days later, the patient received a split-thickness skin graft. To promote the healing process, negative pressure wound therapy (V.A.C. Dressing System; 3M) was utilized. After this 17-day hospitalization, the patient was discharged in stable condition to a long-term care facility.

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