Catastrophic Abdominal Wall After Repair of Enterocutaneous Fistula: A Case Study.

BACKGROUND: Repair of an enterocutaneous fistula (ECF) is challenging, particularly when complications occur. This case describes the use of negative pressure wound therapy (NPWT) and microadhesive dressings with polyabsorbent fibers and an acrylic core, with and without lipidocolloid and nano-oligosaccharide factors, in the management of a patient with a large abdominal wound and ECF. CASE: An 84-year-old woman underwent abdominoperineal resection with colostomy, hysterectomy, and subsequent chemotherapy and radiotherapy for colorectal cancer. She experienced complications, ultimately resulting in ECF of the jejunum. Initial management with NPWT was used to promote abdominal wound healing, while protecting exposed bowel loops proved challenging because of leakage of stoma effluent that impeded the formation of granulation tissue. In order to promote wound healing and prevent infection, we applied a microadhesive dressing composed of polyabsorbent fibers with an acrylic core and lipidocolloid and nano-oligosaccharide factors that facilitated autolytic debridement and healing. CONCLUSIONS: Use of NPWT with the microadhesive dressing proved successful in the management of this complex and challenging ECF.

Combinación de proteasa activa y terapia de presión negativa (TPN) de un solo uso. A propósito de un caso / Active protease and single.use negative pressure therapy (NPT) combination. A case report

Objetivo. Describir la evolución de una úlcera por presión (UPP) sacra de grado III aplicando la combinación del gel de proteasa activa y la TPN. Material y métodos. Descripción de caso clínico de paciente ingresada por perforación intestinal que requirió hemicolectomía derecha, confección de fístula mucosa e ileostomía terminal y colecistectomía. Debido a diversas complicaciones, desarrolló una UPP sacra de grado III. Se iniciaron curas habituales, desbridamiento cortante y, finalmente, se decidió tratamiento con combinación del gel de proteasa activa y TPN de un solo uso. Resultados. Tras desbridamiento quirúrgico de placa necrótica y esfacelos, se aplica gel de proteasa activa y TPN de un solo uso con hidrofibra de hidrocoloide. A los 7 días, la UPP presentó abundante tejido de granulación y mayor limpieza de esfacelo, así como una disminución de 1 cm de profundidad. Conclusiones. En este caso, el proceso de cicatrización de la lesión avanzó y, por lo tanto, la lesión mejoró, aunque no se pudo observar la resolución completa por el traslado de la paciente a otro centro sanitario. Sería conveniente realizar estudios comparativos de ambas terapias por separado para valorar su costeefectividad (AU)

Objective. To describe the evolution of a grade III sacral pressure ulcer (PU) by applying a combination of active protease gel and negative-pressure wound therapy (NPWT). Material and methods. A clinical case of a patient admitted with intestinal perforation requiring right hemicolectomy, mucous fistula, terminal ileostomy and cholecystectomy. Due to several complications, the patient developed a stage III sacral pressure ulcer. Regular cures and debridement were performed. The final treatment of choice was a combination of active protease gel and single-use NPWT. Results. After surgical debridement of necrotic plaque and scrapings, active protease gel and single-use NPWT with hydrocolloid hydrofibre was applied. By the 7th day of treatment, the PU presented abundant granulation tissue, decreased depth by 1 cm. and presented cleaner slough. Conclusions. In this case, the wound’s healing process progressed to a more favorable stage and the injury improved. Unfortunately, the complete healing process couldn’t be followed due to the patient’s transfer to another health center. It would be desirable to conduct comparative studies of both therapies, applied combined and separately, to assess cost-effectiveness (AU)