Stomal mucocutaneous dehiscence as a complication of topical negative pressure used to treat an open abdomen: a case series.
Although mucocutaneous dehiscence in cases of laparostomies is rare, this complication occurred in three patients in The Netherlands (all men, 53 to 65 years old) who received topical negative pressure (TNP) therapy in the management of open abdomens. Two patients experienced anastomotic failure following colonic resection and one had iatrogenic suturing of the small bowel to the fascia. TNP therapy was initiated and stomal dehiscence occurred after 2 to 3 days, contaminating the area. All patients developed sepsis and one died. Two required numerous additional surgeries and antibiotic treatments for 6 and 8 months, respectively. The complication was believed to have occurred as a result of tension on the proximal bowel of the stoma (the bowel inside the abdomen) not due to tension on the sutures or the small part of the bowel outside the abdomen. A modified TNP procedure, consisting of careful placement of the primary dressing around the stoma using separate primary dressing flaps, has since been used without complications in one patient. With implementation of TNP increasing and because of concerns regarding its use, additional research and innovative, simple solutions to manage complex wounds such as the one presented here are needed.
Steenvoorde
Pascal
P
Rijnland Hospital Leiderdorp, Leiderdorp, The Netherlands. psteenvoorde@zonnet.nl
den Outer
Adriaan
A
Neijenhuis
Peter
P
D000368:Aged; D001458:Bandages / Q000009:adverse effects; D003125:Colostomy / Q000009:adverse effects*; D017809:Fatal Outcome; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D008297:Male; D019300:Medical Errors / Q000517:prevention & control; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D009426:Netherlands; D018579:Patient Selection; D011182:Postoperative Care / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology; D017592:Skin Care / Q000295:instrumentation / Q000379:methods; D013529:Surgical Wound Dehiscence / Q000209:etiology* / Q000517:prevention & control; D016896:Treatment Outcome; D014945:Wound Healing