Biological implant and topical negative pressure - 11th ECET Congress Bologna 2011
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BIOLOGICAL IMPLANT AND T OPICAL NEGATIVE PRESSURE FOR THE TREATMENT OF ABDOMINAL DEHISCENCE WITH EXPOSED INTESTINAL LOOP: A CLINICAL NURSING CASE STUDY M. ANTONINI - Enterostomal Therapist – Ostomy and Wound Care Center – ASL 11 Empoli (FI) - Italy – [email protected] G. MILITELLO - Enterostomal Therapist – Ostomy Center – ASL 4 Prato - Italy – [email protected] S. BRUNI – Nurse Specialized in Wound Care – Ostomy and Wound Care Center – ASL 11 Empoli (FI) – Italy) – [email protected] CONCLUSIONS The acellular Porcine dermal collagen (Permacol © ) is a substance with the ability to become vascularized, remodelled in autologous tissue, and to be resistant to infectious processes. In this case, it allowed the formation of new tissue in combination with Topical Negative Therapy. INTRODUCTION The Permacol is an implant of acellular Porcine dermal collagen generally used to repair abdominal incisions, inguinal hernia and, in particular, for the treatment of exposed intestinal loop. MATERIALS AND METHODS The patient underwent surgery to remove a voluminous metastasis of the abdominal wall (20x10 cm) and an additional peritoneal metastasis. A biological prosthesis (Permacol 20x30cm) was positioned. The patient underwent a second surgery because of a necrosis of the skin and subcutaneous exposure of the prosthesis. Because of the partial closure of the breach and an ileal laceration, a new prosthesis application and an ileostomy surgery were necessary. The Permacol was used together with Topical Negative Pressure, in order to help the reduction of the lesion and the formation of granulation tissue in a patient with dehiscence of the abdominal wound and exposed intestinal loop. The management of the dehiscence with advanced wound dressings required almost three changes of the dressing per day because of the massive production of exudate, with considerable discomfort for the patient, prolonged commitment of nursing staff, and high cost for the dressings. The application of the VAC therapy allowed, initially, three dressings per week and then two per week. RESULTS The use of the VAC therapy allowed the optimal management of the massive quantity of exudate. A remarkable reduction of the extension of the laparostomy and the closure of the subcutaneous lesions were recorded. The biological prosthesis with Permacol slowly demoted and the tissue granulation started. Because of the lack of the abdominal wall, gauzes and non-ad (initially with Jelonet, later with Mepitel to reduce bleeding detachment) were used, in order to avoid fistulas and other complications. Necrosis of the abdominal skin Permacol Biological Implant Ileostomy Negative Pressure Wound Therapy (NPWT) NPWT Start – 21 January 2009 18 February 2009 – Granulation tissue 23 March 2009 – The biological implant slowly demoted. A large area of new tissue over the bowel was created. 4 may 2009 – Bleeding of the abdominal wall due to a detachment of Paraffin Gauze Dressing (Jeolonet©). 7 may 2009 – Use of non-adherent silicone dressing (Mepitel©) to reduce bleeding. 7 may 2009 – Matrix of Collagen and Oxidised Regenerated Cellulose (Promogran©). 29 May 2009
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Transcript of Biological implant and topical negative pressure - 11th ECET Congress Bologna 2011
BIOLOGICAL IMPLANT AND TOPICAL NEGATIVE PRESSURE FOR THE TREATMENT OF ABDOMINAL DEHISCENCE WITH
EXPOSED INTESTINAL LOOP: A CLINICAL NURSING CASE STUDY
M. ANTONINI - Enterostomal Therapist – Ostomy and Wound Care Center – ASL 11 Empoli (FI) - Italy –[email protected]. MILITELLO - Enterostomal Therapist – Ostomy Center – ASL 4 Prato - Italy – [email protected]
S. BRUNI – Nurse Specialized in Wound Care – Ostomy and Wound Care Center – ASL 11 Empoli (FI) – Italy) – [email protected]
CONCLUSIONSThe acellular Porcine dermal collagen (Permacol©) is a substance with the ability to become vascularized, remodelled in
autologous tissue, and to be resistant to infectious processes. In this case, it allowed the formation of new tissue in
combination with Topical Negative Therapy.
INTRODUCTION
The Permacol is an implant of acellular Porcine dermal collagen generally used to repair abdominal incisions, inguinal hernia and, in particular, for the treatment of exposed intestinal loop.
MATERIALS AND METHODS
The patient underwent surgery to remove a voluminous metastasis of the abdominal wall (20x10 cm) and an additional peritoneal metastasis. A biological prosthesis (Permacol 20x30cm) was positioned. The patient underwent a second surgery because of a necrosis of the skin and subcutaneous exposure of the prosthesis. Because of the partial closure of the breach and an ileal laceration, a new prosthesis application and an ileostomysurgery were necessary.
The Permacol was used together with Topical Negative Pressure, in order to help the reduction of the lesion and the formation of granulation tissue in a patient with dehiscence of the abdominal wound and exposed intestinal loop.
The management of the dehiscence with advanced wound dressings required almost three changes of the dressing per day because of the massive production of exudate, with considerable discomfort for the patient, prolonged commitment of nursing staff, and high cost for the dressings. The application of the VAC therapy allowed, initially, three dressings per week and then two per week.
RESULTS
The use of the VAC therapy allowed the optimal management of the massive quantity of exudate. A remarkable reduction of the extension of the laparostomy and the closure of the subcutaneous lesions were recorded. The biological prosthesis with Permacol slowly demoted and the tissue granulation started. Because of the lack of the abdominal wall, gauzes and non-ad (initially with Jelonet, later with Mepitel to reduce bleeding detachment) were used, in order to avoid fistulas and other complications.
Necrosis of the abdominal skin Permacol Biological Implant
Ileostomy Negative Pressure Wound Therapy(NPWT)
NPWT Start – 21 January 2009 18 February 2009 – Granulationtissue
23 March 2009 – The biologicalimplant slowly demoted. A large areaof new tissue over the bowel wascreated.
4 may 2009 – Bleeding of theabdominal wall due to a detachmentof Paraffin Gauze Dressing(Jeolonet©).
7 may 2009 – Use of non-adherentsilicone dressing (Mepitel©) to reducebleeding.
7 may 2009 – Matrix of Collagen andOxidised Regenerated Cellulose(Promogran©).
29 May 2009
