title: New technique for treating abdominal surgical site infection using CT woundgraphy and NPWT: A case report.
abstract: BACKGROUND
  Negative pressure wound therapy (NPWT) for abdominal surgical site infection (SSI) is becoming increasingly common, although enterocutaneous fistula (ECF) has been reported as a complication. To avoid ECF, we used computed tomography (CT) woundgraphy to evaluate the relationship between the wound and the intestine, and then safely treated the abdominal SSI with NPWT.
  
  
  METHODS
  Following a laparoscopic intersphincteric resection for low rectal neuroendocrine tumor and covering ileostomy, a 59-year-old woman underwent stoma closure. Six days after surgery, we diagnosed SSI. We suspected ECF, because the wound was deep and the pus resembled enteric fluid. However, CT woundgraphy showed that the wound was separated from the abdominal cavity and the intestine by the abdominal rectus muscle. Accordingly, we performed NPWT. SSI was cured and the wound was well granulated. Twenty-three days after surgery, the patient was discharged. Eventually, the wound was completely epithelialized.
  
  
  CONCLUSIONS
  Although successful NPWT has been reported for open abdominal wounds, ECF is a common complication. ECF can be prevented by separating the wound from the intestine by the omentum or muscle fascia, protecting the intestinal serosa during surgery, and applying low vacuum pressure. The relationships among the wound, the fascia, and the intestine must be evaluated before abdominal SSI treatment. One good method is CT woundgraphy, which evaluates wound extent and depth, closure of muscle fascia, and the relationship between the wound and the intestine.
  
  
  CONCLUSIONS
  We report a case of CT woundgraphy before NPWT for abdominal SSI. CT woundgraphy is a good candidate for evaluating wound condition.
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-city, Tochigi, 329-2763, Japan. Electronic address: i_eisaku_ukasie@yahoo.co.jp.
authors.forename: Eisaku
authors.initials: E
authors.lastname: Ito
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-city, Tochigi, 329-2763, Japan. Electronic address: masashi@iuhw.ac.jp.
authors.forename: Masashi
authors.initials: M
authors.lastname: Yoshida
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-city, Tochigi, 329-2763, Japan. Electronic address: keigo_0613@yahoo.co.jp.
authors.forename: Keigo
authors.initials: K
authors.lastname: Nakashima
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-city, Tochigi, 329-2763, Japan. Electronic address: norinori_sculler@yahoo.co.jp.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Suzuki
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-city, Tochigi, 329-2763, Japan. Electronic address: imakita0626@gmail.com.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Imakita
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-city, Tochigi, 329-2763, Japan. Electronic address: nobuhiro_mihoko@hotmail.com.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Tsutsui
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-city, Tochigi, 329-2763, Japan. Electronic address: ohdaira@iuhw.ac.jp.
authors.forename: Hironori
authors.initials: H
authors.lastname: Ohdaira
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-city, Tochigi, 329-2763, Japan. Electronic address: kitajima@iuhw.ac.jp.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kitajima
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-city, Tochigi, 329-2763, Japan. Electronic address: yutaka@iuhw.ac.jp.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Suzuki
keywords: CT woundgraphy; Negative pressure wound therapy; Surgical site infection