634 Dehisced Functioning Stoma Healed with Novel use of Negative Pressure Wound Therapy

Abstract

Abstract Background Three years following bowel resection and colostomy formation for colorectal cancer a 62 year old man developed a parastomal hernia. On Day11 following laparoscopic repair and stoma formation the midline and stoma wounds dehisced. The stoma had a superficial wound extending 1cm but the lateral edge of this wound had a cavity 4x5x10cm. This wound presented challenges regarding the adherence of both dressings and the stoma bag. Aim During an exploration under anaesthesia, no purulent fluid or mesh was located in the cavity. Initially dressed with betadine wick and a JVAC drain, however, the moisture led to repeated stoma bag detachment and leakage of faeces into the wound. Method Consequently, to speed up healing and contain the faeces, negative pressure wound therapy (NPWT) was used around the stoma. The peristomal area was dressed with hydrofibre and hydrocolloid to provide a base, the cavity with polyvinyl alcohol foam, the stoma protected with Fistula Funnel (3M, San Antonio, Texas) and polyurethane granufoam applied around the wound with a pressure of -150mmHg. Following application of the NPWT a hole was cut to allow stoma contents to be evacuated and a stoma bag applied. Result Within three weeks the cavity was 3x4x1cm and NPWT discontinued. Conclusion The use of NPWT is contraindicated over exposed organs and the need for an occlusive dressing presents active outflow of contents. However the use of a soft, flexible silicone funnel allowed a complex wound to be healed in weeks, when conventional treatment wound have taken months.