RESUMO
BACKGROUND: Repair of an enterocutaneous fistula (ECF) is challenging, particularly when complications occur. This case describes the use of negative pressure wound therapy (NPWT) and microadhesive dressings with polyabsorbent fibers and an acrylic core, with and without lipidocolloid and nano-oligosaccharide factors, in the management of a patient with a large abdominal wound and ECF. CASE: An 84-year-old woman underwent abdominoperineal resection with colostomy, hysterectomy, and subsequent chemotherapy and radiotherapy for colorectal cancer. She experienced complications, ultimately resulting in ECF of the jejunum. Initial management with NPWT was used to promote abdominal wound healing, while protecting exposed bowel loops proved challenging because of leakage of stoma effluent that impeded the formation of granulation tissue. In order to promote wound healing and prevent infection, we applied a microadhesive dressing composed of polyabsorbent fibers with an acrylic core and lipidocolloid and nano-oligosaccharide factors that facilitated autolytic debridement and healing. CONCLUSIONS: Use of NPWT with the microadhesive dressing proved successful in the management of this complex and challenging ECF.
Assuntos
Parede Abdominal/cirurgia , Fístula Intestinal/cirurgia , Parede Abdominal/anormalidades , Parede Abdominal/fisiopatologia , Técnicas de Fechamento de Ferimentos Abdominais , Idoso de 80 Anos ou mais , Bandagens/efeitos adversos , Bandagens/tendências , Neoplasias Colorretais/complicações , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Fístula Intestinal/fisiopatologia , Tratamento de Ferimentos com Pressão Negativa/métodos , Cicatrização/efeitos dos fármacos , Cicatrização/fisiologiaRESUMO
La eventración paraestomal (EP) es la complicación tardía más frecuente del estoma quirúrgico. Solo se interviene un tercio de éstas, hecho que en parte se explica por el alto índice de recidivas observadas tras la reparación.Se presenta el caso de un paciente portador de cistoprostatectomía radical y derivación tipo Bricker, sometido a reparación de EP. Se describen complicaciones postoperatorias que requieren un abordaje de alta complejidad y técnica depurada para la resolución de necrosis en la urostomía más abdomen catastrófico por pérdida de pared.El empleo de dispositivos adecuados, accesorios y terapia de presión negativa, junto con la coordinación entre la estomaterapeuta y el enfermero de práctica avanzada, asegura una correcta evolución del paciente y favorece que pueda marchar de alta en las mejores condiciones posibles
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