Necrotising soft tissue infection and management of a stoma after extensive abdominal wall soft tissue loss

Ms Colleen Mendes1
1Royal Prince Alfred Hospital, Camperdown, Australia

Background: Extensive loss of abdominal wall soft tissue creates a complex and challenging situation where a stoma is formed in the absence of abdominal wall skin or subcutaneous tissue.  This case study describes a 64 year old male who was admitted  in acute septic shock with a perineal mass and necrotising soft tissue infection extending over the abdominal wall. He underwent surgical debridement of the affected tissue, perineal proctectomy with wide excision of the anal sphincter and formation of colostomy.

Aim: The aim of this presentation is to describe a technique for isolation of a stoma that has been formed onto abdominal wall fascia, surrounded by negative pressure wound therapy dressing.

Method: The fascia surrounding the stoma was covered with a silicone dressing and a mouldable seal before a fistula isolation device was applied. The negative pressure dressing foam was cut to fit between the two bridges of the fistula isolation device. The abdominal defect was covered with foam dressing. With the negative pressure applied, the consitina in the fistula isolation device contracted down around the stoma and a bag was able to be applied.

Conclusion: The use of the fistula isolation device successfully separated the newly formed stoma from the negative pressure dressing allowing stoma maturation, complex abdominal wound management and avoidance of enteric contamination of the wound.


Biography:

Colleen Mendes is a Clinical Nurse Consultant in Stomal therapy at Royal Prince Alfred Hospital, Sydney, She has a 25 year nursing career, with 10 years specialising in this field. Colleen has extensive experience in stoma, wound, continence, antigrade colonic irrigation, sacral nerve neuromodulation programming and anorectal physiology.

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