Case Study 2:
The ITI Wound Treatment System enables active healing for a medically complicated patient
Description
A 61-year-old Caucasian female was transferred from an area medical center to a long-term acute care (LTAC) hospital for wound and ostomy care. The patient - diagnosed with invasive colon adenocarcinoma with metastatic disease to the lymph nodes - had undergone multiple surgeries, including a colon resection. Subsequently, the anastomosis was found to be leaking, requiring emergency surgery to form an ileostomy.
When initially admitted to the LTAC hospital, the patient had a very large horizontal wound covered with wet eschar. The ileostomy resided within the borders of the abdominal wound, with stool from the ileostomy flowing freely over the wound surface. The wound had been managed by the transferring hospital with an extra large wound pouching system. Upon assessment, the wound care team initiated a new approach - negative pressure wound therapy (NPWT).
After debridement, the ITI Wound Treatment System with foam dressings was used to provide continuous negative pressure at -120 mmHg. The ileostomy was managed with a two-piece pouching system and Eakin Cohesive® Seal to separate the pouching system from the wound surface. The foam dressing was changed after the first 24 hours; subsequently, the dressing was changed and assessed every Monday, Wednesday, and Friday per protocol.
Results
Upon admission, the patient's wound was measured at 23.0 (L) x 55.0 (W) x 5.5 (D) cm. On Day 23, the patient's wound had healed by 87.8%. At this point, the patient was discharged to a skilled nursing facility for continued wound care.
The patient returned to the LTAC hospital on Day 35, as a result of non-related symptoms - at which time the wound was measured and shown to have reduced 41.44% from the dimensions recorded 12 days previously (see table). These results demonstrated that the ITI Wound Treatment System was able to facilitate the repair of a large abdominal wound through support of granulation in a medically complicated patient.
Conclusion
The ITI Wound Treatment System and foam dressings enabled a wound care team to successfully treat this older and medically complicated patient, avoiding sepsis and prolonged discomfort. The patient achieved complete granulation of the wound site without complications. Despite the patient's diagnosis of liver metastasis, the wound healed completely.
Case submitted by: C. Hofferber RN BSN CWOCN, Select Specialty Hospital, Omaha, NE.