With the purpose of decreasing surgical site infection and improving wound cosmesis after colostomy takedown, a case report of the NPseal negative pressure wound therapy device used over the dirty wound of a Hartmann’s colostomy reversal was evaluated. Wound cosmesis and exudate production were evaluated.

A 66-year-old male presented to the emergency department with two days of increasing abdominal pain in the left lower quadrant. CT scan of the abdomen and pelvis demonstrated Hinchey Grade IV diverticulitis with feculent peritonitis. He received intravenous fluids, antibiotics were initiated, and he was prepped for a planned Hartmann’s procedure. Procedure was completed without complication and the patient recovered well at home. His colostomy was evaluated for takedown 3 months later as the intra-abdominal inflammation resided. In the OR the colostomy was taken down from the abdominal wall and a colorectal anastomosis was performed. The colostomy site fascia was closed with 1.0 PDS suture and the elliptical colostomy site was closed loosely with 4.0 Monocryl without tension. The NPseal was removed from its packing and the plastic protectors over the adhesive ends were removed. The NPseal was placed directly on top of the closed colostomy site and the edges were smoothed out so there were no wrinkles allowing for air escape. The NPseal was pumped 12 times until the center tubing remained collapsed signifying a pressure of -125mmHg and the patient was taken to the PACU.

Throughout the patient’s hospital course, the NPseal negative pressure wound therapy device held suction and did not require additional pumping of the center chamber. The patient did not complain of any discomfort from the device and the device did not become overly saturated with exudate necessitating removal and replacement. On postoperative day 3 the patient was cleared for discharge and the patient was discharged home with the device in place. The patient was given instructions on how to care for the device at home. At the patients home the NPseal remained in place, holding suction until postoperative day 6 when the patient was told to remove the device from his colostomy takedown site. On return to clinic on postoperative week 4, the colostomy takedown site incision was clean with no wound infection and the noticeable scar was minimal. The patient was pleased with the appearance of the scar. 

The patient found the NPseal negative pressure wound therapy device to be comfortable and easy to manage. In the process of closing a contaminated colostomy wound the patient experienced excellent wound cosmesis, no postoperative discomfort with the dressings, and no postoperative would complications. The NPseal negative pressure wound therapy device produces a cost effective and efficacious method for improving wound cosmesis and decreasing wound exudate buildup in the setting of a closed dirty wound. The small self-contained unit of the NPseal dressing allowed the patient to remain mobile, shower and dress as normal. 

• NPseal negative pressure wound therapy device was easy to maintain.
• The colostomy takedown site dressed with the NPseal negative pressure wound therapy device showed excellent wound cosmesis at post operative week 4.
• NPseal negative pressure wound therapy device was easy to manage and remove at home without the supervision of a healthcare provider.
• Patient was able to mobilize, shower and dress with the NPseal negative pressure wound therapy device in place.

Hartmann’s Procedure

Post-operative day 6 picture of colostomy closure site