Portable NPWT unit successfully treats a large complicated abdominal surgical dehiscence after laparotomy

INTRODUCTION: In the last decade, the number of patients treated with negative pressure wound therapy (NPWT) addressing surgical wound dehiscence has increased to one of the top applications of NPWT. Single patient NPWT pump usage is common but wound size has been a limiting factor. This case study documents the successful management of a large complicated dehisced abdominal wound managed with a full function, lightweight, personal use, NPWT pump at the patient’s home. 

METHODS: A 41 year old male presenting with a perforated diverticulitis, abscesses, and adhesions. Laparoscopic converted to open lysis of adhesions, resulted in resection of colon (Hartmann’s procedure) and colostomy.  Burn and wound team recommended management of open abdominal wound (necrosis requiring colon resection and placement of a new colostomy). Fascia to fascia closure was obtained, however the surgical site and subcutaneous tissue dehisced. The patient met criteria for a clinical trial evaluating a more mobile homecare portable NPWT unit on return to clinic. 

RESULTS: Wound initial size, 25.0 x 6.0 x 4.4 cm (baseline).  Primary  goal of therapy: Decrease wound volume. Secondary goal: Increase granulation tissue. Goals achieved in 3 weeks with wound decreased to 15.0 x 0.6 x 0.1 cm.  A 40% decrease in length, 90% decrease in width, and a 98% decrease in depth in just 3 weeks.  Overall percent of change was 99.9% decrease in overall size.  The wound healed 100%, the following week after NPWT was discontinued. 

CONCLUSION: With the small portable NPWT unit, the goal of the therapy treatment for a large complicated abdominal wound was successfully reached in the 3rd week and full closure was observed in 4th week. No complaints of pain, and no issues with maintaining seal. The small device allowed mobility to maintain activities of daily living. Moreover, the clinicians were satisfied with the device usage and performance.