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Advanced Techniques in the Use of Negative Pressure Wound Therapy for Closure of Complex Neonatal Abdominal Wounds

Bayci, Andrew; Akay, Begum

Journal of Wound Ostomy & Continence Nursing: September/October 2018 - Volume 45 - Issue 5 - p 468–471
doi: 10.1097/WON.0000000000000471
Challenges in Practice

BACKGROUND: Negative pressure wound therapy (NPWT) has been described for closure of complex neonatal abdominal wounds, but advanced techniques for stoma or fistula control, skin protection, and the use of high pressure therapy not as well established.

CASES: We identified neonatal patients at our institution who received NPWT for a complex abdominal wound, defined as a wound associated with a stoma or fistula with partial or complete dehiscence of the abdominal fascia or skin. We then reviewed techniques for decreasing wound contamination and protecting the newborn's skin. One patient had an especially complex wound; she was born at ∼23 weeks' gestational age (birth weight 580 g). She developed necrotizing enterocolitis and strictures, requiring multiple surgeries to relieve obstruction, ultimately resulting in an end ileostomy with mucous fistula. She suffered from wound dehiscence and retraction of her surgically created stoma, resulting in a complex abdominal wound with significant damage to the surrounding skin. We used advanced NPWT techniques to heal her wound, including topical skin protectants, placement of an adhesive dressing over the skin prior to placement of negative pressure dressing, placement of a negative pressure sponge directly on the wound bed and stoma, diversion of enteric contents away from the wound using a Malecot catheter, and an increase in the negative pressure applied.

CONCLUSION: Complex neonatal abdominal wounds can be treated effectively using NPWT. The techniques we describe divert enteric contents away from the wound bed while maintaining negative pressure and protecting the surrounding skin. In addition, we used negative pressure up to −125 mm Hg and found it was well tolerated by our patients.

Andrew Bayci, MD, Department of General Surgery, Beaumont Health, Royal Oak, Michigan.

Begum Akay, MD, Department of Pediatric Surgery, Beaumont Children's, Royal Oak, Michigan.

Correspondence: Andrew Bayci, MD, 5021 Prentis Dr, Troy, MI 48085 (Andrew.Bayci@gmail.com)

The authors declare no conflicts of interest.

© 2018 by the Wound, Ostomy and Continence Nurses Society.