Here - EWMA 2013

POSTER PRESENTATIONS
P 368
Use of NPWTi in a critical surgical patient
Poster: Case Study
Jenny Atzeni 1 , Giuseppe Salamone 1
1 Policlinico Universitario P. Giaccone (Palermo, Italy).
Aim: Purpose of this case report is to highlight the importance of the use of negative
pressure wound therapy with controlled instillation of fluids (NPWTi) in a critical surgical
patient, with prior evisceration, abundant loss of substance in correspondence with the
laparotomy wound and infection of the same.
Methods: Female patient, 61 y.o. Underwent anterior resection of the rectum for
adenocarcinoma. Occurrence of dehiscence and subsequent packaging of terminal
colostomy. Reoperation for detachment of the colostomy and suture dehiscence with
partial evisceration. Positive blood culture for Klebsiella P, infection of the wound with
positive culture for Enterococcus spp (fig1). Use of NPWTi with metronidazole for 30
days, until almost complete healing of the wound and discharge.
Results: From the moment it is started NPWTi on the surgical wound, with instillation of
metronidazole, it was possible to see a clear improvement in the general clinical
condition of the patient and almost complete healing of the surgical wound (fig2).
Conclusions: NPWT increases blood flow and tissue perfusion, promotes granulation
tissue formation, and also reduces wound size faster than standard moist wound care.
NPWT instillation combines NPWT and the timed delivery of topical irrigation solutions to
the wound bed, in this case were used antimicrobials. Data analysis shows positive
efficacy for the treatment of infection. In the case described this approach to the wound
has also allowed an improvement of the general clinical condition of the patient.
*Figures not available in abstract book
POSTER: CASE STUDY
P 369
Use of NPWTi in Fournier’s gangrene
Poster: Case Study
Giuseppe Salamone 1 , Jenny Atzeni 1
1 Policlinico Universitario P. Giaccone (Palermo, Italy).
Aim: Fournier’s gangrene (FG) is defined as a fulminant form of infective necrotizing
fascitis of the perineal, genital or perianal regions. Even with appropriate treatment
approaches, mortality is high as 4 to 67%. There have been many advances in
management of Fournier gangrene including use of vacuum assisted closure and
hyperbaric oxygen therapy.
Methods: A 72 y.o. male with swelling, redness, pain on palpating and necrosis of the
penis, scrotum and perineal area including the perianal area, with diabetes mellitus type
II, previous non Hodgkin lymphoma recent surgery for perianal fistula, was admitted in
our clinic. Because of the extensive involvement of the anus and its sphincter was
necessary, as the first surgical time, the packaging of a terminal colostomy on sigma.
After that, he underwent radical surgical debridement with excision of all necrotic
material (fig1). Have been made abundant washing with hydrogen peroxide and
betadine. Was used negative pressure wound therapy with controlled instillation of fluids
(NPWTi)(fig2). The treatment was then completed with hyperbaric oxygen therapy. This
treatment was performed for 40 days until discharge.
Results: The surgical treatment associated with NPWTi and hyperbaric oxygen therapy
have allowed the resolution of the septic and an almost complete wound healing (fig3).
Conclusions: Early recognition and aggressive surgical excision are mandatory for
success in patients with Fournier’s gangrene. The use of NPWTi in the treatment of
Fournier’s gangrene improves clinical outcomes and reduces hospital stay.
*Figures not available in abstract book
214