Open Rectal Prolapse Repair
With the purpose of decreasing surgical site infection and improving wound cosmesis after open pelvic surgery, a case report of the NPseal negative pressure wound therapy device over a pfannenstiel incision was completed. Wound cosmesis and exudate production were evaluated.
A 73 female with rectal prolapse was seen in clinic and noted to have rectal prolapse on clinical examination. The patient was taken to the operating room and a lower pfannenstiel incision was made to facilitate identification of the redundant sigmoid colon. Absorbable mesh was sutured to the pelvic floor and suspended to the sacral prominence. The peritoneum was closed with Vicryl and the anterior rectus fascia was closed with 1 PDS suture. The incision was then closed 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 incision. The edges were smoothed out so there were no wrinkles allowing for air to 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 for recovery.
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. On return to clinic on postoperative week 4, the pfannenstiel incision site was clean with no wound infection and the noticeable scar was minimal. The patient was pleased with the appearance of the scar.
In summary, the patient found the NPseal negative pressure wound therapy device to be comfortable and easy to manage. This patient experienced excellent wound cosmesis, no postoperative discomfort with the dressings, and no postoperative wound complications. The NPseal negative pressure wound therapy device produced a cost effective and efficacious method for excellent wound cosmesis and minimizing wound exudate buildup. 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 lower pfannenstiel incision dressed with the NPseal negative pressure wound therapy device showed excellent wound cosmesis at post operative day 30.
- 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.
Lower pfannenstiel incision with NPseal
Post-operative week 4 picture of pfannenstiel closure site