Stoma Intubation, Isolation and Negative Pressure Wound Therapy for Complex Stoma-Associated Wounds: New Technique and Case Series

Background: The use of negative-pressure wound therapy (NPWT) in colorectal surgery has been demonstrated for treating perineal defects, enterocutaneous fistula and stoma dehiscence. Here we describe a technique for closure of complex stoma-associated wounds using a novel commercial intubation device alongside NPWT to protect the surrounding wound from the stoma effluent. Clinically the patients were managed by an MDT approach including specialist nurse practitioners, dieticians, colorectal nurses, stoma nurses and critical care. The device has previously described for use with enterocutaneous fistula. We present two cases that have been successfully treated with this technique. Technique and Cases: The first case is of an 88 year-old women with a retracted loop ileostomy and the second a 48 year-old male with a retracted end colostomy. Both patients underwent significant emergency peristomal debridement and in both cases the commercial device was deployed to intubate the stoma. VAC foam and standard adhesive dressings were used to form a quality seal and the pressure set to 125mmHg. In both cases near complete healing was achieved to the point that standard stoma bags and management could be used. Conclusion: This is the first description of the use of an isolation device in complex stoma associated wounds. We have found the Fistula Funnel to be safe in this context.