2005 Symposium on Advanced Wound Care | |
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Case Study
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Closure of an infected, dehisced myelomengiocele wound in a neonate with negative pressure wound therapy Mona M. Baharestani, PhD, ANP, CWOCN, CWS, Long Island Jewish Medical Center, New Hyde Park, NY Myelomeningocele is a protrusion of the meninges, spinal fluid and portion of the spinal cord through a defect in the vertebra. Treatment of the neonate with myelomeningocele involves early surgical closure of the defect to protect the neural tissue. This case report describes the successful use of NPWT* in the management of a 3.5 week old neonate who sustained an infected dehisced vertebral wound after repair of a myelomeningocele with duroplasty and myofascial flap closure. The neonate’s infected wound was managed with parenteral antibiotics, multiple debridements and wet to dry dressings three times daily for 21 days, with resultant increasing size and renecrosis. Upon consultation by the author, further bedside debridement was performed and after assuring that there was no CSF leak, NPWT* was instituted. The original goals were: increased granulation, decreased bacterial burden, increased vascularity and decreased wound dimensions in order to achieve ultimate closure through skin grafting. But, after 19 days of NPWT*, the wound was so small, with granulation to skin level, that the neonate was discharged home and his mother was taught to perform weekly collagen-alginate dressings† covered with a hydrocellular foam‡. Total wound closure was achieved by secondary intention. * V.A.C.® registered trademark of KCI, Inc., San Antonio, Texas † Fibracol Collagen-Alginate Wound Dressing, Johnson & Johnson Wound Management, a division of Ethicon, Inc., Somerville, New Jersey ‡ Allevyn, Smith & Nephew, Inc., Largo, Florida |
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