Woundcare for Open Abdominal Wounds

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Woundcare for Open Abdominal Wounds

• Patricia Wijnands
• Woundcare specialist STER
• Stuivenberg/St.-Erasmus

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Introduction

• Indication for open abdominal wounds
• Problems conservative treatment
• Treatment with VAC
• Apply VAC on open abdomen
• Case report
• Cost
• Conclusion

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Indication for open abdomen

• Obstruction or perforation intestine
• Pancreatitis
• Necrotising faciitis
• Abdominal trauma
• Intra-abdominal hypertension
• Abdominal Compartiment Syndrome

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Treatment open abdomen (temporary closure
techniques)

• Skin approximation
• Marlex with Zipper
• Absorbable Mesh (Vicryl)
• Bogotá bag
• Vacuum Assisted Closure

Kaplan. et al
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Problems conservative therapy

• Difficult, heavily labor and time due to dressing
  changes
• Leakages
• Generation of skin injuries due to moisture
• Delayed woundhealing
• Fistula and hernia
• Re-exploration daily
• Risk for sepsis ?
• Extended hospital and IC stay
• Mortality rate ?

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Conservative therapy
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Treatement with VAC?

• Vacuum Assisted Closure
• Non-invasive, active wound healing technique
• Fully controlled negative pressure

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Contra-indications

• Maligne tissue
• Fistula
• Bloodvessels or organs
• Necrotic tissue

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Objectives VAC Open Abdomen

• Removal oedema and excessive wound exsudates
• Approximation wound edges
• Improves new bloodvessels
• Stimulates new tissue formation
• Removes infectious materials
• Protecting against contamination
• Protecting fascia (rectraction)
• exposed to air fistula
• damage to fascia hernia

(Jones et al, 2005 and Banwell et al, 2002),
(Kaplan. et al)
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Bandages Open Abdomen

• Abdominal dressing and Granufoam (black)
• Special layer ? protecting intestine
• Large drainage capacity
• Formation granulation tissue
• Woundcontraction
• Exsudating wounds
• Infection

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Point of interest

• Specific odeur interaction between foam and
  exsudates, bacteria, proteins etc
• Rinsing wound
• Changes dressing

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Apply VAC Open Abdomen in operating theatre!!!
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Removal PU-film
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Evaluating woundbed and depth
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Disinfection
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Preparation foam
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Choose size
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Prepare foam and PU-film
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Create opening in PU-film and place Trac-Pad
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Stoma
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Case report 1

• Morbide obesity
• Bariatric surgery
• Anastomosis leak
• Necrotising fasciitis (clostridium perfringens)
• Aspergillus pneumonia
• Transfer for HBO

32 years
Septic shock
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Re-explorationHyperbaric Oxygen therapy
Day 0
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Re-exploration
Day 1
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Re-exploration and start VAC
Day 2
klik
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VAC treatment
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VAC treatment
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VAC treatment
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Day 2
Day 12
Day 17
Day 26
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VAC treatment pressure sore
04/12/06
08/12/06
12/01/07
25/01/07
26/01/07
24/01/07
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Case report 2

• Short bowel obstruction (bride)
• Re-anastomosis
• Evisceration
• Leakage short bowel

80 years
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Treatment with VAC
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Adapt paste
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Treatement cost 3 days

• VAC-therapy
• Abdominal dressing
• Rent VAC-unit
• 50/ 300 euro / 3 d.
• (use of foam)
• Nursing cost ICU none
• Explor. laparotomy 1 x
• Admission (LOS) ?

?

• Conservative therapy
• (gauze)
• Bandage, tape, sterile fluid, cavillonspray,
  scheet, geri-care, clovs
• Cost bandage 180 euro/ 3 d.
• Nursing cost ICU 18u / 3 d. (3u/day X 2 nurses)
• Explor. laparotomy 3 x
• Admission (LOS) ?

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Treatement cost Open abdomen
?

• Conservative therapy

• VAC-therapy

- 8.235 euro
Reduce 27 LOS
Song, D Wu, L Lohman, R Gottlieb, L
Franczyck, M. Vacuum Assisted Closure for
Treatment of Sternal Wounds The Bridge Between
Debridement and Definitive Closure. Plastic and
Reconstructive Surgery 2003 Vol 11 92-97
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Treatement cost Philbeck et al
?

• Conventional therapy

• VAC-therapy

Wound closure/ day 0,090 cm2
0,23 cm2 Calculation healing
time? wound 22.2 cm2
247 days 97 days Conclusion VAC
cost effective in use
.
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Conclusion VAC

• A BIG step forward in treatment of the open
  abdominal wounds
• Woundhealing ? comfort ?
• Complications ? (sepsis, mortality)
• Heavy Labor ? and Staff ?
• Detailed examination of pharmaco-economical
  efficiency
• Not reach out for life saving technology due to
  lack of insight real costs.

Kaplan M (2004) Negative Pressure Therapy in the
Treatment of the Opened Abdomen Where are we Now
and Will We get There? Presented at the VAC
National Educational Conference, New York.
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Relevant publications Open abdomen, e.o.
www.woundvac.com/ KCI Medical BV.
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Bookavailableat WSACSBooth
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23 chapters 308 pages 43 tables 148 figures
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Thanks for your attention