Three Cases of Surgical Site Infection-Related Wound Dehiscence Treated with Negative Pressure Wound Therapy with Instillation and Dwell Time and Dialkylcarbamoyl Chloride

Abstract

INTRODUCTION: Surgical site infection (SSI)-associated wound dehiscence offers management challenges, often requiring frequent and prolonged wound care to achieve healing. Dehiscence may result in evisceration, requiring careful attention to infection management and organ protection, leading to extended hospitalization, poor cosmesis, increased costs, and higher risks of incisional hernias, all of which reduce patient satisfaction. Herein, we outline 3 cases in which the combination of negative pressure wound therapy with instillation and dwell time (NPWTi-d) and deep cavity wound dressing and protective agent (Sorbact) enabled safe and early wound healing.CASE PRESENTATION: Case 1: A 76-year-old man underwent open ileocecal resection for bowel obstruction secondary to cecal cancer. On POD 3, an SSI was observed, and on POD 6, bowel evisceration resulting from wound dehiscence occurred, necessitating reoperation for suture closure. NPWTi-d was initiated 2 days after reoperation. On POD 9, extensive necrotic tissue was observed at the wound base, and Sorbact was applied while continuing NPWTi-d. On POD 34, favorable granulation tissue formation was noted, and skin closure was performed. Case 2: A 94-year-old man underwent a Hartmann procedure for a sigmoid colonic perforation. On POD 10, wound erythema and purulent discharge were noted, leading to wound opening. As a result, NPWTi-d was initiated. Partial fascial dehiscence with bowel exposure was observed on POD 19. Extensive necrotic tissue was present; thus, Sorbact was applied, and NPWTi-d was continued. On POD 38, granulation tissue formation was deemed favorable, and NPWT was discontinued. Case 3: A 77-year-old man underwent a Hartmann procedure for rectal cancer perforation. On POD 9, an SSI was noted, and wound irrigation was initiated. On POD 13, partial fascial dehiscence with bowel exposure was observed, with necrotic tissue at the wound base. Sorbact was applied, and NPWTi-d was initiated. Gradual granulation tissue formation was achieved, and NPWT was discontinued on POD 40, followed by skin closure.CONCLUSIONS: Wound dehiscence resulting from SSI markedly impairs patients’ quality of life and presents a major therapeutic challenge. The combination of NPWTi-d and Sorbact enabled safe and effective treatment for refractory wounds.