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Treatment of Wound Dehiscence Utilizing Negative Pressure Wound Therapy With Instillation and Dwell Time in Emergency Abdominal Surgery: A Step-by-step Closure Protocol.

BACKGROUND
The treatment of complex wounds often requires multiple surgical debridements and, eventually, reconstruction with skin grafts or flaps. Topical negative pressure therapy with a vacuum-assisted closure device can achieve wound healing with a reduction in healing time and easier management of the wound.


OBJECTIVE
With a step-by-step closure protocol developed by the authors from July 2017 to the present, this case series highlights the advantages of using negative pressure wound therapy with instillation and dwell time (NPWTi-d).


MATERIALS AND METHODS
The authors report the treatment of 13 patients undergoing emergency abdominal surgery. In total, 5 patients (38.46%) had hollow bowel perforation, 4 patients (30.77%) had intestinal occlusion, 3 patients had cancer (23.08%), and 1 patient (7.69%) underwent extensive ileal resection due to intestinal infarction.


RESULTS
The use of NPWTi-d reduced the number of dressing changes compared with saline-soaked gauze dressings. Instillation resulted in faster and better wound bed cleansing compared with traditional dressings. Exudate management was better, and the average complete wound closure time was faster than with traditional dressings. The step-by-step closure protocol made it possible to accelerate wound healing; in synergy with NPWTi-d, tension at the edges of the middle third of the wound, especially in the xipho-pubic wounds, had reduced significantly.


CONCLUSIONS
The synergistic action of step-by-step closure and NPWTi-d obtain excellent results in management of wound dehiscence, even in patients with muscle fascia defect and loop exposure.