NEGATIVE PRESSURE WOUND THERAPY IN THE MANAGEMENT OF ABDOMINAL SURGICAL WOUND DEHISCENCE IN PATIENTS WITH MULTIPLE COMORBIDITIES

Background: Dehiscence of abdominal wounds is often a clinical and surgical challenge, especially in patients with multiple comorbidities. Negative Pressure Wound Therapy (NPWT) is a treatment based on controlled negative pressure. Objectives: Our experience concerning NPWT in 2 patients affected with surgical abdominal wound dehiscences and significant comorbidities is reported and discussed. Methods: Both the patients has been treated using V1STA® (Smith & Nephew), a device based on the Chariker-Jeter technique (a flat/tubular drain embedded in the wound bed, on a layer of saline-moistened gauze, completely covered by other layers of gauze placed in the wound to fill the defect to the skin level; an adherent plastic membrane attached over the dressing and the surrounding skin to convert the open wound in a closed, controlled system; the drain is connected to a canister, linked to the NPWT suction system), with a -70/80 mmHg continuous suction. Patient A, a 43 years old woman affected with type 1 advanced-stage spinocerebellar ataxia, chronic pain not responsive to morphine, abdominal distension related to hepatomegaly and enteric hypotonia, had a 8,5x1x2,5cm median laparotomy wound dehiscence (related to a subtotal colectomy for megacolon, enteral hypotonia), yet unsuccessfully treated for a month with traditional methods (contaminated and dead tissue removal, frequent changes in wound dressings). Patient B, a 75 years old woman, affected with class III obesity (BMI: 44), diabetes mellitus type I, colonic diverticular disease, was admitted to our Surgical Unit with a 20x8x6cm median laparotomy wound dehiscence, developed after a left emicolectomy, performed for a diffuse peritonitis due to a colonic diverticulum perforation. Results: In both patients no side effects were recorded. Patient A was treated for 20 days with NPWT. Complete resolution of the wound dehiscence was recorded at day 30th. Patient B was discharged 9 days after the admittance at our Surgical Unit (NPWT was applied on the 2nd day). Nowadays (42 days after discharging) she’s still in treatment with NPWT, followed at our outpatient clinic, where the dressing changes are performed two times/week; dehiscence (actually 10x5x2,5cm) is healing, with no signs of infection. Conclusion: Several studies validated NPWT efficacy reducing oedema, evacuating fluids from the extravascular space of the wound margins and bed, improving bacterial clearance, increasing local blood perfusion, stimulating the proliferation of fibroblasts and neo-angiogenesis. NPWT is a well-tolerated option, which has been used for several types of wounds (sternal, abdominal, vascular wounds, decubitus ulcers, etc..), offering increased patient comfort, less nursing time spent with dressing changes, and, in some cases, outpatient management. NPWT may be considered a succesful method in the management of wound dehiscences in patients with difficult healing wounds and important comorbidities.