ID Design 2012/DOOEL Skopje, Republic of
Macedonia
Open Access Macedonian Journal of Medical Sciences.
https://doi.org/10.3889/oamjms.2017.060
eISSN: 1857-9655
Case Report
|
|
Treatment of Decubitis Ulcer
Stage IV in the Patient with Polytrauma and Vertical Share Pelvic Fracture,
Diagnosed Entherocollitis and Deep Wound Infection with Clostridium
Difficile with Combined Negative Pressure Wound Therapy (NPWT) and
Faecal Management System: Case Report
Slavcho Stojmenski1*, Igor Merdzanovski1,
Andrej Gavrilovski1, Sofija Pejkova2, Gjorge Dzokic2,
Smilja Tudzarova2
1University Clinic for Traumatology, JZU – Clinic for TOARILUC,
Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje,
Republic of Macedonia; 2University Clinic for Plastic and
Reconstructive Surgery, Medical Faculty, Ss Cyril and Methodius University
of Skopje, Skopje, Republic of Macedonia
AIM:
The aim of this paper was to present a case with the successful treatment of
decubitis ulcer stage IV in the patient with polytrauma and vertical share
pelvic fracture and diagnosed entherocollitis combined with deep wound
infection with Clostridium difficile treated with combined Negative
Pressure Wound Therapy (NPWT) and faecal management system.
CASE REPORT:
Patient D.S.1967 treated on Traumatology Clinic after tentamen suicide on
9.2.2015 with diagnosis: brain contusion; contusion of thoracal space;
vertical share pelvic fracture; open fracture type II of the right calcaneus;
fracture of the left calcaneus; fracture on the typical place of the left
radius; fracture of the right radius with dislocation. As a first step
during the treatment in Intensive care unit we perform transcondylar
extension of the left leg, and in that time we cannot operate because of the
brain contusion. Four weeks after this treatment we intent to perform
stabilisation of the pelvic ring, fixation of both arms, and fixation of
both calcanear bones. But at the time before performing the saurgery, the
patient got an intensive enterocollitis from Escherichia colli and
Clostridium difficile, and during the inadequate treatment of
enterocollitis she got a big decubitus on both gluteal regia Grade IV and
deep muscular necrosis. Several times we perform a necrectomy of necrotic
tissue but the wound become bigger and the infection have a progressive
intention. In that time we used VAK system for 6 weeks combined with faecal
management system and with local necrectomy and system application of
Antibiotics and Flagyl for enterocollitis in doses prescripted from
specialists from Infective clinic. This new device to manage faecal deep
decubital infection and enterocollitis with Clostridium difficile are
considered as adequate. 8Flexi-Seal® FMS has been also used. After two
months we succeed to minimize the gluteal wound on quoter from the situation
from the beginning and we used for next two months wound treatment from
Departement for Plastic and Reconstructive Surgery.
CONCLUSION:
When faecal incontinence as a result of enterocollitis with Clostridium
difficile does occur, a limiting contact with the patient’s skin is
extremely important as breakdown can occur rapidly. In addition to tissue
injury, faecal incontinence can have a major impact on the patient’s dignity
and result in prolonged hospital stay. The main outcomes assested in the
case studies were resolution of of decubital ulcers as a result of faecal
incontinence, patient comfort and ease of application of the FMS and NPWT.
The soft flexible catheter was easily inserted without discomfort to the
patients. It gently conformed to the rectal vault, reducing significantly
the risk of necrosis, and the risk for prolonged necrosis in cases with
previously developed necrosis. FMS was successful in diverting faecal fluid
away from the perineal tissue and resolved any decubitus ulcer developed
previously in combination with use of NPWT. So, we can recommend this
combination in those cases especially with polytraumatismus, vertical share
pelvis fracture combined with diarrhea and deep wound infection of decubital
ulcers Grade IV infected with Cl. difficile.
..................
Citation: Stojmenski S, Merdzanovski I,
Gavrilovski A, Pejkova S, Dzokic G, Tudzarova S. Treatment of Decubitis
Ulcer Stage IV in the Patient with Polytrauma and Vertical Share Pelvic
Fracture, Diagnosed Entherocollitis and Deep Wound Infection with
Clostridium Difficile with Combined Negative Pressure Wound Therapy (NPWT)
and Faecal Management System: Case Report. Open Access Maced J Med Sci.
https://doi.org/10.3889/oamjms.2017.060
Keywords: decubitis ulcer stage iv; polytrauma; vertical share pelvic
fracture; entherocollitis; deep wound infection; clostridium difficile;
combined negative pressure wound therapy (NPWT); faecal management system.
*Correspondence: Slavcho Stojmenski. University Clinic for
Traumatology, JZU – Clinic for TOARILUC, Medical Faculty, Ss Cyril and
Methodius University of Skopje, Skopje, Republic of Macedonia. E-mail:
stojmenski@on.net.mk
Received: 11-Feb-2017; Revised: 24-Mar-2017; Accepted: 30-Mar-2017; Online
first: 03-Jun-2017
Copyright: © 2017 Slavcho Stojmenski, Igor Merdzanovski, Andrej
Gavrilovski, Sofija Pejkova, Gjorge Dzokic, Smilja Tudzarova. This is an open-access article
distributed under the terms of the Creative Commons Attribution-NonCommercial
4.0 International License (CC BY-NC 4.0).
Funding: This research did not receive any financial support.
Competing Interests: The authors have declared that no competing
interests exist.
|
<
Previous
|
Next Article >
Table of contents
This Article
(free)
Full text (pdf)
Full text OnlineFirst (pdf)
Google Scholar
-
Stojmenski S
-
Merdzanovski I
-
Gavrilovski A
-
Pejkova S
-
Dzokic G
-
Tudzarova S
PubMed
- Stojmenski S
- Merdzanovski I
- Gavrilovski A
- Pejkova S
- Dzokic G
- Tudzarova S
|