Treatment of Extensive necrotizing abdominal wall infection
Michael Schurr, MD
Mountain Area Health Education Center; Asheville, NC
- In April of 2020, a 56-year-old female presented with an incarcerated ventral hernia which led to necrosis of the strangled intestinal tissue and abdominal wall.
- Consequently, she was in septic shock.
- Extensive intestinal and abdominal surgery was performed to remove necrotic tissue and fix hernia.
- Intestines were reattached using the stapled ileocolonic anastomosis method.
- Delayed wound closure and healing by secondary intention was chosen to monitor for infection before closing.
- Systemic antibiotics
Procedure & Treatment
- After extensive intestinal surgery, 14 pieces of Microlyte® Surgical 4”x 4” sheets were placed on the wound and left to heal by second intention for approximately 2 weeks.
- When wound was confirmed as infection free, then closed with sutures.
- A wound vac was placed to manage drainage and promote healing.
- Wound was checked approximately once a month, for 3 more months.
- One month after abdominal closure, patient’s incisional sutures were still in place and wound vac still secure. Some undermining was noted.
- One month later, patient continued to do well, and undermining was resolved. Exudate was minimal and free of purulence.
- At month three, she continued to improve with only lateral aspects of the wound open. NPWT was continued. No drainage or erythema was observed.
- Patient is free of infection and wound is greater than 90% healed with small lateral aspects remaining open which is being treated with Microlyte® Surgical.
- Ventral hernia repairs have an SSI rate of up to 23%, and incarcerated hernias are associated with a poor prognosis. Necrotizing infections are severe conditions with a high mortality rate due to sepsis and the subsequent multi-organ failure. And bowel resection, as this patient experienced, adds another layer of risk.
- The addition of Microlyte® Surgical to the surgical protocol may have been instrumental in controlling the bioburden of the wound, thereby allowing the wound to progress out of the inflammatory stage and onto healing.
Microlyte® Matrix shows promise as an adjunctive therapy when healing by second intention is indicated.
A. 14 sheets of Microlyte Surgical were used as the primary dressing after debridement.
B. Wound is greater than 90% healed and free of infection