Management of Nonviable Tissue Buildup in Abdominal Wounds

Abstract Body: In cases where full closure is not achieved after open abdominal surgery, patients are left with open cutaneous wounds with knotted, heavy sutures at the wound base, providing fascial closure. The goal for these wounds is secondary wound closure; however, non-viable tissue and slough readily develops around the suture knots and delays healing. Repetitive sharp debridement is needed to remove the non-viable tissue, so minimizing non-viable tissue buildup would benefit patients tremendously. In this study, we retrospectively compared two groups of patients (14 male, 7 female) from 20- to 77-years old, who underwent the same abdominal surgical closure procedure, resulting in cutaneous abdominal wounds with knotted sutures at the wound base. In Group 1, 14 patients received continuous negative pressure wound therapy (NPWT*) at -125 mmHg. In Group 2, 7 patients received NPWT with instillation and dwell time (NPWTi-d†) using a reticulated open-cell foam dressing with through holes (ROCF-CC‡). Normal saline (30-60 mL) was instilled onto the wounds with a dwell time of 10 minutes followed by 3.5 hours of NPWT at -125 mmHg. In both groups, dressings were changed every 2-3 days. The fascial closure remained intact in both groups; in Group 2, none of the instilled saline was able to enter the abdominal cavity. In Group 1, 100% of patients developed non-viable tissue, requiring up to 23 weekly postoperative sharp debridements. In Group 2, no patients experienced non-viable tissue buildup, and no subsequent sharp debridements were required. Data from this study suggest that NPWTi-d using ROCF-CC dressings is a valid option for helping manage abdominal wounds with heavy sutures applied, which prevents instillation solution from entering the abdominal cavity (instillation into the open abdomen is contraindicated by the manufacturer). The author now uses NPWTi-d with ROCF-CC dressings to help manage non-viable tissue buildup in this wound type.