Isolating 2 Connected Wounds With the Paste Cork Technique
Elizabeth Claire StipekABSTRACT
BACKGROUND
Fecal contamination from fistulae delays wound healing, especially when 2 interconnected wounds each have their own fecal source. This article describes a complex case of a patient with a colonic fistula and retracted ostomy draining into 2 connected wound spaces. Comorbid conditions such as malnutrition, diabetes mellitus, trauma-related stress, and nonadherence to treatment further impeded healing, underscoring the need for effective stool isolation techniques.
CASE
A 46-year-old man experienced a penetrating abdominal trauma that required multiple abdominal surgeries resulting in a frozen abdomen. He developed 2 connected wounds: one contained a coloatmospheric fistula, and the other contained an ostomy recessed to the fascial level. Initially, the midline coloatmospheric fistula was pouched and effluent from the ostomy was managed with a rectal tube by the surgical team; however, this proved ineffective for drainage because the tube was repeatedly expelled owing to peristalsis. The viscosity of the effluent and presence of undigested debris prevented use of negative pressure wound therapy (NPWT) over the entire wound. Therefore, I developed and implemented the Paste Cork Technique which uses NPWT along with ostomy paste to isolate the 2 connected wounds, preventing contamination if the fistula or ostomy were to leak. The isolation using the Paste Cork Technique was successful even after stool leakage occurred.
CONCLUSION
Isolation of the 2 wounds was consistently achieved for 2-3 days, and output was accurately monitored. The combination of the NPWT and stool isolation expedited complete wound healing and fistula and ostomy takedown.