P-036 CLOSURE OF INFECTED LAPAROSTOMY WITH NPWTI (NEGATIVE PRESSURE WOUND THERAPY WITH INSTALLATION) TO ON-LAY POLYPROPYLENE MESH IN A SEVERELY SARCOPENIC PATIENT

Abstract

Abstract Aim To demonstrate NPWTi allows using polypropelene mesh in infected wounds in a patient with sarcopenia at high risk of developing incisional hernia. Methods This case describes a severely unwell 50 year-old with a gangrenous caecal volvulus and severe sarcopenia and hypoalbuminaemia. He underwent a right hemicolectomy and ileostomy and on ITU intubated. His wound grew yeast and vancomycin-resistant enterococcus, he developed large bilateral flank collections and on day 8 dehisced. Results A washout and laparostomy with mesh partial closure plus silicone-coated dressing was performed. At 48 hours Abthera@ fill was applied and the mesh was trimmed and tightened for gradual closure. Subsequent washouts showed mesh was fixated on the posterior rectus sheath with several holes caused by stitches used to fixate it. As such, the anterior rectus sheath was divided, creating a flap bilaterally. The posterior sheath flaps were reapproximated but the anterior sheath couldn't be, but was kept in place without tension by securing a polypropylene mesh and a NPWTi (Veraflo.) Successive returns to theatre showed the mesh was intimately attached to aponeurosis and rectus muscle and subsequently there was exuberant granulation tissue on top of mesh. Skin was closed, again with NPWT. Despite leakage from his stoma, he now has a clean healed wound. Conclusion NPWTi enabled use of polypropylene mesh in a very hostile wound with gross contamination in a sarcopenic patient with high risk of developing incisional hernia. It is still a short follow up but we expect with this technique will avoid hernia formation.