Negative Pressure Wound Therapy for Open Wounds with Enterocutaneous Fistula—Two Case Reports—

Abstract

Negative pressure wound therapy (NPWT) effectively promotes wound healing ; however, it is contraindicated for the management of enterocutaneous fistula. We describe two cases of an open wound associated with an enterocutaneous fistula treated with NPWT. The exposed bowel was protected with non-adhesive gauze following drainage and closure of the fistula, and this strategy led to significantly improted wound healing.

Case 1 : A 67-year-old woman who underwent Hartmann's procedure for a perforated sigmoid colon diverticulum developed wound dehiscence secondary to colon stump necrosis. The exposed bowel was covered and protected with nonadhesive gauze prior to NPWT application.

Case 2 : A 65-year-old woman who underwent pelvic exenteration for radiation enterocolitis and rectal cancer developed midline wound dehiscence secondary to Procedure-induced bowel injury. The exposed bowel was covered and protected with nonadhesive gauze prior to NPWT application. In both cases, low suction pressure was used, and initially, we performed dressing exchanges on a daily basis. The suction pressure was gradually increased and the rate of exchange was reduced. Finally, uncomplicated wound healing occurred in both patients. We emphasize that NPWT can be safely performed even in open wounds with enterocutaneous fistula after ensuring that the exposed bowel is adequately protected following fistula closure.