Evaluating the Application of an Elastomeric, Advanced Skin Protectant in Periwound Care and the Use of Customizable Isolation Devices for Fistula Management

Abstract

Skin maintenance is critical during fistula and ostomy management. Leakage of enteric output can cause skin breakdown and denudement. Fistula and stoma management is multidisciplinary with multimodal interventions.1,2 Here, 2 patients received an elastomeric, advanced skin protectant* in periwound care while fistula management encompassed customizable, one-piece, compressible isolation devices†‡. Patient 1 was a 45-year-old female with abdominal wall cellulitis and mesh-associated intra-abdominal infection, who developed an enteroatmospheric fistula. Prior medical history included illicit drug use with pregnancy, emergent C-section, necrotizing fasciitis of the abdominal wall, and cardiovascular comorbidities. An elastomeric, advanced skin protectant provided a barrier to protect damaged skin, creating an environment that supports healing. Negative pressure wound therapy (NPWT§) created an environment to promote wound healing, while a fistula isolation device accommodated the stoma. Mesh was applied over the defect, protected, and bolstered with NPWT. Reconstructive surgery entailed mesh excision and panniculectomy. Incisional NPWT managed the partially closed incisions and incisional openings occupied with polyvinyl alcohol (PVA) foam dressing to wick fluid.3 Upon dressing change, the PVA foam** dressing was removed. The patient was discharged home with closed incision negative pressure therapy†† with dressing changes every 7 days. Patient 2, a 26-year-old female, with spina bifida and an open abdominal wound with fistula. This young lady had a difficult to pouch urostomy and ileostomy adjacent to the wound. Her skin was denuded and tender. After placing the elastomeric advanced skin protectant and a fistula isolation device her skin healed and no further leaking or skin breakdown was found. In these two cases, modalities for fistula isolation and stoma management were integral to recovery with special attention toward periwound care.

*3M™ Cavilon™ Advanced Skin Protectant (3M, St. Paul, Minnesota); Fistula Funnel®; Wound Crown® (Fistula Solution Corporation, St. Paul, MN); §V.A.C. Therapy; **V.A.C. WHITEFOAM™ Dressing; ††PREVENA Closed Incision Management System (3M Company)

References

  1. Gribovskaja-Rupp I and Melton GB. Enterocutaneous Fistula: Proven Strategies and Updates. Clin Colon Rectal Surg. 2016 Jun;29(2):130-7.
  2. Carla I. Haack CI, Galloway JR and Srinivasan J. Enterocutaneous Fistula: A Look at Causes and Management. Curr Surg Rep. 2014; 2:71.
  3. Chopra K, Tadisina KK, Singh DP. The 'French Fry' VAC technique: hybridisation of traditional open wound NPWT with closed incision NPWT. Int Wound J. 2016 Apr;13(2):216-9. doi: 10.1111/iwj.12266. Epub 2014 Apr 3. PMID: 24698495.

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