Augmentation in Prevention and Treatment of Juxta-Anal Wound Complications with an Indwelling Fecal Management System
Abstracts
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The management of stool of all consistencies in the bedridden population can be challenging, labor intensive and lead to perianal excoriations, skin breakdown and complicate existing neighboring wounds or catheters. Severe wounds with ongoing contamination are often considered for defunctioning stoma to divert the fecal stream to allow improved wound care or in preparation for flap reconstruction. The purpose of this study is to review the benefits of a recently developed Indwelling Fecal Management System (IFMS: ZME, Inc, Fernandina Beach, FL, USA) that has been used to provide immediate nonsurgical fecal diversion or critical bowel management in acutely ill or chronically bedridden hospitalized patients who were at risk for repetitive fecal soiling causing complications of existing juxta-anal wounds or breakdown of surrounding skin. (Methods) From May 1997 to September 2001, 49 patients at Yeungnam University Hospital were managed with IFMS for severe diarrhea or complicated juxta-anal wounds.The management consisted of aggressive debridement, wound care and antibiotics as indicated. Stool was evacuated spontaneously via the IFMS in the case of diarrhea. In individuals with normal stool, twice a day warm saline irrigations through the IFMS or 600-900 cc of PEG solution in 3 divided doses was administered to facilitate evacuation. Weekly endoscopic examinations were performed to rule out mucosal injury. 6 patients had anorectal manometry studies performed on the day of IFMS removal and 3 days later to evaluate any functional changes in the anal sphincter. (Results) 47 patients (M:F::30:17) were managed with IFMS. Patients' median age was 54 years (range, 28-76). Average duration of use was 14.1 (range, 3 - 63) days. No endoscopic evidence of injury was noted. All patients healed their wounds to the point of surgical or secondary closure without need for defunctioning colostomy or had prevention of further juxta-anal skin breakdown. No clinical fecal incontinence was noted on removal. Those who underwent manometric evaluation showed decreased mean resting and squeeze pressure, but with marked improvement after repeat evaluation in 3 days. There was no mortality in the group.. (Conclusions) IFMS provides effective augmentation to traditional wound care strategies for patients with severe diarrhea or juxta-anal wounds without need for defunctioning colostomy without causing rectal mucosal or functional injury. |
