(CS-006) Management of Infected Dehisced Abdominal Wounds with Adjunctive Negative Pressure Wound Therapy and Instillation of a Topical Wound Solution

Body‐contouring procedures following weight loss are prone to complications including delayed wound healing, secondary wound dehiscence, postoperative hematoma, or seroma.^1,2 Full-thickness abdominal surgical wound dehiscence following abdominoplasty or liposuction is a severe postoperative complication that requires immediate treatment and can lead to prolonged hospital stay, high incidence of incisional hernia and subsequent reoperations.³ Negative pressure wound therapy with instillation and dwelling (NPWTi-d) of a topical wound solution has been shown to aid in automatic cleansing of the wound surface, solubilizing devitalized tissue for removal, removing infectious exudate, and reducing bacterial load.^4,5 We report our experience with NPWTi-d to adjunctively manage three massive, infected dehisced abdominal wounds following abdominoplasty or liposuction.

Methods:

NPWTi-d was applied with hypochlorous acid solution via a reticulated open-cell foam dressing with through holes (ROCF-CC) in 3 full-thickness surgically dehisced abdominal wounds of 3 patients following elective body-contouring surgery. Systemic antibiotics were administered, and sharp surgical debridement was performed prior to or in conjunction with NPWTi-d application. Infection was confirmed via non-contact real-time fluorescence imaging. NPWTi-d settings included instilling hypochlorous acid every 2.5 to 3.5 hours with a 10-15 minute dwell time between cycles of continuous negative pressure at -150 mmHg. Imaging technologies (non-contact real-time fluorescence wound imaging and non-contact near infrared spectroscopy studies) were used at each dressing change to guide clinical decision making. Dressings were changed 3 times/week. NPWTi-d was discontinued when the wound was clear of infection, at which time patient was transitioned to outpatient care with conventional NPWT.

Results:

At admission, infection was confirmed for all wounds, and percent surface area slough coverage was 15%-50%. Following the initial surgical debridement, wound size volume ranged from 130.6 cm³ to 1,186.1 cm³. Average time to infection clearance/patient discharge was 8.7 days (range: 7-11 days), and wounds were healed in 7.9 to 12.8 weeks.

Discussion:

Rapid conversion in each case to a non-infected wound with clean granulating wound base allowed for quick transition from hospital to outpatient care. NPWTi-d facilitated hydromechanical debridement as evidenced by removal of devitalized tissue through the ROCF-CC dressing. Following NPWTi-d, all wounds progressed to closure without further sequelae.