[size=20px]A former 2.7-kg, ex 34-week premature infant was born with gastroschisis. The patient’s course was complicated by ischemic bowel requiring a prolonged use of silo. At 3 weeks of age, the fascia and skin are unable to be closed. A temporary mesh is placed to close the fascia. What is a contraindication of using negative pressure wound therapy (NPWT) in this patient?

 

A Weight of patient

 

B History of prematurity

 

C Exposed bowel

 

D Exposed mesh

 

E Exposed superior mesenteric artery​[/size]

D

D

D

I think the correct answer is E, exposed superior mesenteric artery. Negative pressure wound therapy (NPWT) should not be used when there is an exposed superior mesenteric artery as it could lead to further tissue damage and disruption of blood supply.

correct answer

E Exposed superior mesenteric artery

 

Negative pressure wound therapy (NPWT), also called vacuum-assisted closure (VAC) therapy has been used in adults for over 20 years. This method of wound closure is safe and versatile with a low incidence of complications. Use of NPWT has also been widely used in infants and children. NPWT may be used as a bridge to definitive wound closure in children with complex wounds, abdominal compartment syndrome, and abdominal sepsis. NPWT has also been used for definitive closure in children with pilonidal disease, burns, and sternal wound dehiscence following cardiac surgery. Studies also suggest NPWT may prevent wound infections and wound dehiscence. A recent study described the use of NPWT in contaminated and dirty/infected wounds. The skin edges were approximated with buried absorbable sutures and the skin surrounding the wound was protected with plastic strips followed by placement of the sponge for NPWT. This technique resulted in a low wound infection rate of 3.1%. Another recent study showed use of NPWT following primary posterior sagittal anorectoplasty prevented postoperative wound dehiscence.

 

Although use of NPWT has become more prominent in infants and children, there are no specific devices for pediatric patients. Most will modify the existing adult NPWT device for the use in infants and children. The standard suction used for NPWT in adults is -125 mmHg and this pressure is generally used in children older than 4 years. Most use -50 mmHg for premature infants and -75 mmHg for neonates and small children (< 4years of age).

 

NPWT is contraindicated over big blood vessels as hemorrhagic deaths have been reported in adults. Placement of NPWT devices directly over nerves should also be avoided. Exposed surgical hardware and mesh are not a contraindication to NPWT. Use of NPWT directly over bowel and anastomoses has been questioned but not a contraindication for its use. Finally, NPWT may also be used in the presence of enteric fistula with many advocating to isolate the fistula from the wound.

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E