Negative pressure wound therapy - case report
Languages of publication
The postoperative wound dehiscence is a rare complication of surgical procedures. It is more common among geriatric patients and those undergoing chemotherapy. A more frequent complication is a postoperative bowel obstruction, which also occurred in the presented case. One of the advanced therapeutic techniques in wound infections and complex wound failure (CWF) is the use of negative pressure on the wound surface to improve healing. It is sometimes combined with implantation of monofilament mesh to reconstruct the abdominal wall. A 76-year-old woman diagnosed with ovarian cancer (IV FIGO stage), after chemotherapy, was referred to the Department of Obstetrics, Gynecology and Oncological Gynecology in Bytom for surgical treatment. Postoperative course was complicated by intestinal obstruction and abnormal wound healing with extensive necrosis and fascial dehiscence. Patient required multiple relaparotomies with wound revisions, during which vacuum dressing and monofilament, polypropylene mesh filling the gap in the fascia were implanted. At intervals of 3-4 days, the wound was examined and the dressing was replaced. The mesh was gradually cut, what allowed to bring the fascia edges closer together. During the tenth intervention, the dressing was removed and the skin was sewn. The case illustrates that the combination of using non-absorbable synthetic materials and vacuum assisted closure therapy is highly effective in the treatment of complex wound failures with extensive dehiscence of abdominal wall. The gradual cutting technique of the implantation mesh allows the fascia edges to completely close the wound.
-  Bee TK, Croce MA, Magnotti LJ et al. Temporary abdominal closure techniques: a prospective randomized trial comparing polyglactin 910 mesh and vacuum-assisted closure. J Trauma 65 (2008) 337–342
-  Acosta S, Bjarnason T, Petersson U et al. Multicentre prospective study of fascial closure rate after open abdomen with vacuum and mesh-mediated fascial traction. Br J Surg 98 (2011) 735–74
-  World Cancer Report 2014. World Health Organization (2014) Chapter 5.12.
-  Reid BM, Permuth JB, Sellers TA. Epidemiology of ovarian cancer: a review. Cancer Biology & Medicine 14 (2017) 9-32.
-  Girolimetti G, Perrone AM, Santini D, et al. BRCA-Associated Ovarian Cancer: From Molecular Genetics to Risk Management. BioMed Research International 2014; 2014: 787143. doi: 10.1155/2014/787143.
-  Morrison J, Haldar K, Kehoe S, Lawrie TA. Chemotherapy versus surgery for initial treatment in advanced ovarian epithelial cancer. Cochrane Database of Systematic Reviews 2012 Aug 15; Issue 8, CD005343. doi: 10.1002/14651858.CD005343.pub3.
-  Pavlidis T, Galatianos I, Papaziogas B, et al. Complete dehiscence of the abdominal wound and incriminating factors. Eur J Surg. (2001) 351–354
-  Webster C, Neumayer L, Smout R, et al. Prognostic models of abdominal wound dehiscence after laparotomy. Journal of Surgical Research 109(2) (2003) 130–137
-  Shanmugam, V. K. et al. Postoperative wound dehiscence: predictors and associations HHS Public Access. Wound Repair Regen 23 (2015) 184–190
-  Banaszkiewicz, Z. et Jawie, A. Negative pressure therapy in treatment of hard-to-heal wounds. Leczenie Ran 9 (2012) 141-145
-  Mooney SJ, Winner M, Hershman DL, et al. Bowel Obstruction in Elderly Ovarian Cancer Patients: A Population-Based Study. Gynecologic oncology 129 (2013) 107-112
-  Menzies D, Ellis H. Intestinal obstruction from adhesions - how big is the problem? Ann Cell Surg Eng 72 (1990) 60-63.
-  Monk BJ, Berman NL, Montz FJ. Adhesions after extensive gynecologic surgery: Clinical significance, etiology, and prevention. Am. J. Obstet. Gynecol. 170 (1994) 1396-1403
Publication order reference