Colorectal Cancer: Open Access

Keywords

Nursing care; Wound care; Urinary fistula; Granulation; Advanced medication; Vac terapy

Introduction

The clinical case report management of a deep sacral wound crater (anterio-posterior perineal), 26 cm length and 20 cm depth, in a woman experiencing a cloacla neoplasia. The patient was a young woman of 46 years old, she had an abdominoperineal resection and a coccygectomy surgery, hysteroannesectomy, permanent endcolostomy, urinary fistula (Figure 1).

Figure 1: Deep wound in the sacral side with a urinary fistula.

Objectives

A urinary fistula became a complication in the wound management. The first objective of the treatment was to avoid crtitical colonizations and systemic infections.

Methods

Step 1: In the first week the wound was packed on a daily base filling the cavity with a iodoform gauze. The wound appeared with an aboundant exudate inside the cavity with slaugh and necrotic tissue (Figure 2).

Figure 2: Wound treated with iodoform gauze.

Step 2: After the wound was treated with a dressing of sodium carboxymethylcellulose impregnated with ionic silver enhanced by ethylenediaminetetra-acetic acid di-sodium salt and benzethonium chloride.

For 18 days the dressing has been changed on a daily base (Figure 3).

Figure 3: Wound treated with sodium carboxymethylcellulose impregnated with ionic silver enhanced by ethylenediaminetetra-acetic acid di-sodium salt and benzethonium chloride.

Results

The dressing allowed the management of the exudates and bacterial colonization; clinical signs of localized or systemic infection has never been reported in the wound despite the presence of bacteria (Escherichia coli) and the urinary fistula [1-5]. In 8 months the wound reduced his dimension (8 cm length; 3 cm width; 6 cm depth); the wound bad has been maintained clean and the sacral stump was covered by granulating tissue (Figure 4).

Figure 4: Lesion covering by granulating tissue.

Conclusion

At first the urinary fistula didn’t allow the treatement with negative pressure therapy. The decision of treating the wound with advanced wound dressing has been a success. In 8 months the wound reduced his dimension without any infections of the wound bad with the evidence of an active tissue healing process (Figure 5).

Figure 5: A- Deep wound at time 0. B- Deep wound after advanced medication.

References

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3. Speck KE, Arnold MA, Ivancic V, Teitelbaum DH (2014) Cloaca and hydrocolpos: laparoscopic-, cystoscopic- and colposcopic-assisted vaginostomy tube placement. J PediatrSurg49:1867-1869.
4. Greer SE, Duthie E, Cartolano B, Koehler KM, Maydick-Youngberg D, et al.(1999)Techniques for applying subatmospheric pressure dressing to wounds in difficult regions of anatomy. J Wound Ostomy ContinenceNurs 26: 250-253.
5. Berdah SV, Mariette C, Denet C, Panis Y, Laurent C, et al.(2014) A multicentre, randomised, controlled trial to assess the safety, ease of use, and reliability of hyaluronic acid/carboxymethylcellulose powder adhesion barrier versus no barrier in colorectal laparoscopic surgery. Trial 15: 413.