ARE TEMPORARY STOMAS HELPFUL TO MANAGE COMPLEX WOUNDS? Rosine van den Bulck BRUSSELS
WHY TEMPORARY STOMAS? Patient AGE AGING POPULATION CO MORBIDITIES OVERALL CONDITION MULTIPLE SURGICAL PROCEDURES POOR SURGICAL, HEALING CONDITIONS SURGERY EMERGENCY SURGERY DIFFICULT TO MANAGE STOMAS/WOUNDS
WHY TEMPORARY STOMAS? Surgery diagnosis Diagnosis,RMN, Ultra sounds.. Mini invasive surgery anesthesia Improved quality of anesthesia Mechanical staples anastomosis Low sutures, anastomosis protection Temporary stoma
WHY TEMPORARY STOMAS? Type of stoma
WOUND COMPLICATION RISK FACTORS Distribution of risk factors (n=117) Risk factors Cases Dehiscence % Old age (>50 years) 19 4 20% Smoking 44 3 07% Obesity 15 2 13% Malnourishment 23 3 13% Malignancy 14 2 15% Post-operative ileus 29 4 14% Chest complications 32 5 17% Wound infection 29 7 25% Post-operative vomiting 45 3 06% Waqar et al, 2005
INCIDENCE OF ABDOMINAL WOUND COMPLICATION Any patient undergoing a surgical procedure is at risk of developping wound complications Age, use of steroids, chemotherapy, Rxtherapy, diabetes predispose to wound complications Incidence is higher after laparotomy, emergency surgery
CLINICAL CASES
Organ Dysfunction Abdom inal Hypertension INTRA ABDOMINAL PRESSURE Normal Abdominal Pressure Abdominal Compartment Syndrome 0 5 10 15 20 25 30 35 40 Intra-abdominal Pressure (mmhg)
INTRA ABDOMINAL HYPER PRESSURE LATE DECOMPRESSION
Intra abdominal Hyperpressure MONDAY 10am Wednesday Wednesday4 pm
EMERGENCY SURGERY IMMUNO SUPPRESSIVE TREATMENT CAECUM PERFORATION FAECAL PERITONITIS, FISTULAS laparotomy DELAYED HEALING ILEOSTOMY KIDNEY TRANSPLANT
CAECUM PERFORATION ILEOSTOMY SMALL BOWEL FISTULAS SKIN PROTECTION POUCH PARENTERAL NUTRITION
CHILDREN IMPERFORATED ANUS
Temporary colostomy
CHILDREN; TEMPORARY COLOSTOMY NO APPLIANCES NO SKIN DISORDERS
TEMPORARY ILEOSTOMY IN OBESE PATIENTS ANASTOMOSIS PROTECTION NO APPROPRIATE APPLIANCES AVOID RIGID CONVEXITY
SURGERY FOR SMALL BOWEL CANCER OLD LADY WITH ARTERITIS LAPAROSCOPIC SURGERY MAJOR HAEMATOMA IN EARLY POST OP BOWELS ISCHAEMIA SECOND SURGICAL PROCEDURE LAPAROTOMY + ILEOSTOMY RECURRENCE OF BOWELS ISCHAEMIA TOTAL DEHISCENCE+STOMA NECROSIS
SMALL BOWEL ISCHAEMIA RECURRENCE ON STOMA explore the stoma
SMALL BOWEL ISCHAEMIA RECURRENCE ON STOMA TOTAL STOMA DEHISCENCE Surgical emergency RECURRENCE OF PRIMARY DISEASE, ARTERITIS
FOURNIER s GANGRENE ACUTE AND SEVERE MULTI BACTERIAL INFECTION HAPPENS VERY OFTEN AFTER ABDOMINAL OR PERINEAL SURGERY INCIDENCE IS HIGHER IN MEN WITH DIABETES and OVER SIXTIES SURGICAL DEBRIDEMENT URINE AND STOOLS DIVERSION DEPENDING ON WOUND LOCALISATION ANTIBIOTHERAPY WOUND MANAGEMENT
FOURNIER s GANGRENE
FOURNIER s GANGRENE
AFTER DEBRIDEMENT
STOMA, BLADDER CATHETER, NPWT
FOURNIER s GANGRENE REVERSAL SURGERY WHEN PERINEUM WOUND IS HEALED
NECROTIZING FASCIITIS 60 YEARS OLD LADY COUPLE OF YEARS AGO, MULTIPLE SURGICAL PROCEDURESWITH MAJOR COMPLICATIONS HYSTERECTOMY ABDOMINAL HYPER PRESSURE SMALL BOWL FISTULA 2 ND DAY POST OP ILEOSTOMY SKIN NECROSIS IN PERISTOMAL ZONE MALODOUR
Necrotising fasciitis after hysterectomy exposed bowels PRIORITY; BOWELS PROTECTION ILEOSTOMY TO BYPASS FISTULA POUCHING PROBLEMS STOMA CLOSE TO THE WOUND
NECROTIZING FASCIITIS AFTER 12 DAYS OF NEGATIVE PRESSURE THERAPY «ABTHERA»
MAJOR WOUND COMPLICATION 71YEARS OLD MAN OBESE 160kg 2005 PROSTATE CANCER TREATED BY BRACHETHERAPY SMALL BOWEL RESECTION + UROSTOMY FISTULA IN POST OP ILEOSTOMY RENAL FAILURE IN POST OP WOUND INFECTION TISSUE NECROSIS
COMPLICATION POST BRACHYTHERAPIE INFECTION PLAIE+ FISTULE
COMPLEX ABDOMINAL WOUND UROSTOMY AND ILEOSTOMY NEGATIVE PRESSURE+WOUND INSTILLATION
STOMAS TO MANAGE THE WOUND EMERGENCY SURGERY
Conclusion When planning the care of patients with complex abdominal wounds and stoma consideration must be given to : psychological and social needs of the patient The effect of altered body image The patient motivation to comply with wound and stoma management
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