PMC5786218_01
Wound dehiscence and deep surgical site infection after laparotomy, with multiple fistulas at the surgical site and at the old drainage wound (colostomy bag). The catheter placed is a tube ileostomy.
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On postoperative Day 15, intestinal contents were excreted through the laparotomy wound and postdrain wound, as shown in Fig. 1. The patient had developed multiple ECF with a total output of 1500 mL/24 h (Fig. 1).
One month after conservative treatment without NPWT. The active high output fistulas are pointed with yellow circles.
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After unsatisfactory results using conservative wound care for 31 days, as shown in Fig. 2, NPWT was used on the fistulas and the wound surrounding the fistulas, using intermittent pressure of -70 mmHg (5 min of negative pressure and 2 min of rest). Local debridement was performed and new granufoam was reapplied on the wound surface once every 3 days (Figs 2 and 3).
After first application of NPWT. White foam was applied on wound surfaces with fistulas, and covered using a black granufoam. The remaining wound surfaces without fistulas were covered using black granufoam alone.
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Local debridement was performed and new granufoam was reapplied on the wound surface once every 3 days (Figs 2 and 3).
Wound condition after 1 week treated using NPWT, with three low fistulas remaining, as indicated using yellow circles.
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No complications occurred (Figs 4-7).
Wound condition after 1 month treated using NPWT, with one low fistula remaining. Healthy granulation tissue indicates the wound is ready for closure.
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No complications occurred (Figs 4-7).
Wound condition after closure using Keystone flap, with window around one active low output fistula.
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No complications occurred (Figs 4-7).
One month after closure using flap. Wound contracted, with no active fistula.
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No complications occurred (Figs 4-7).