ThTP8.6 A novel method for stoma isolation in a complex abdominal wound treated with vacuum assisted closure
Nick Browning, James Thornton, Andrew Smith- Surgery
Abstract
Introduction
Vacuum assisted closure (VAC) is a well established method in the treatment of abdominal wounds where the fascia is intact. The presence of one or multiple intestinal stomas or fistulae may present challenges in successful application of VAC therapy. Key concerns with the presence of intestinal stomas alongside open abdominal wounds is the risk of contamination with stoma effluent or the potential for the negative pressure to create enterocutaneous fistulae. Here we describe a novel method for isolating a small bowel stoma existing within a large abdominal wound, allowing successful resolution having failed conventional management.
Method
No device currently exists to allow a functioning stoma to be isolated within an abdominal wound requiring VAC therapy. This method relies on modification of a standard silicone fistula crown, this is then integrated into the standard VAC dressing, using stoma seals to provide successful vacuum. Stoma output is then successfully isolated, protecting surrounding tissue and supporting wound granulation without concern of wound effluent contamination.
Discussion
Of key importance in this case is the proximity of clean wounds with skin grafts done by plastic surgeons also being managed with VAC therapy and the importance of preventing contamination to allow successful granulation without further debridement of an already large wound.
Conclusion
Although this situation is rare with the increasing use of vacuum assisted closure devices for the management of wounds across many specialities this scenario is certainly not unprecedented. The technique described allowed successful treatment of a complex wound with significant existing comorbidities allowing resolution of a very challenging situation.