I have a patient who had a failed mesh placement and a panniculectomy and who has developed at least three separate fistulas with a very large amount of output (3-4 L/24 hrs). Any suggestions? I am using an Eakin wound management pouch hooked up to wall suction.
An Overview of Neonatal and Pediatric Wound Care Knowledge and Considerations
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Apaucity of pediatric wound care research is available upon which to guide practice; few wound care products have been studied in this population.1-3 This problem is compounded further by the ethical and litigious issues involved in carrying out research in this vulnerable population, leaving clinicians without an evidence base from which to render care. In fact, it is not unusual for skin care regimens to be based on individual or institutional preference and routine.4 Most papers on wound care in neonates and children are anecdotal or are discussions of wound healing principles and clinical practice guidelines for adults.1 Research data regarding the safety and clinical efficacy of wound care dressings, drugs, and adjunctive treatments in neonates and children are needed.3,5
Although they follow the same wound healing trajectory as adults, wounds in neonates and children typically exhibit faster rates of closure.6-8 Fibroblasts are present in greater numbers, collagen and elastin are more rapidly produced, and granulation tissue forms more quickly compared to adults.8,9 In fact, rapid, uncomplicated wound healing requiring limited healthcare professional intervention is the “normative expectation” in pediatrics.10 This expectation of rapid, uneventful healing and innate age-related integumentary resiliency has, in part, resulted in the lack of wound care knowledge transfer to the pediatric population.10 Pieper et al’s1 recent study of 13 home care agencies found that while children represented 3% of all visits and 17% of children had wounds, basic principles of wound care were not implemented into practice. Pressure ulcers and open surgical wounds among this pediatric population often were cleansed with hydrogen peroxide, household soap, or povidone-iodine — 44% were treated with dry gauze and 19% with normal saline dampened gauze.1 Yet, more than 90% of the home care nurses interviewed for this study described the pediatric wound care as appropriate.1 Similarly, a survey11 among 104 neonatal intensive care units (NICUs) in the US found that less than 25% had wound care protocols in place. A survey of 13 NICUs in the UK reported wound care practices to be wide and varied with neither written policy nor guidelines for staff.12 In fact, 32% of wounds were either left open to air or covered with dry dressings, with the prevailing view of staff participating in the study that plastic surgery would cure the wound at a later time.12 Although eight of the units surveyed had access to wound specialists, only one unit reported use of this specialty.12 Baker et al’s13 US survey of 305 NICUs also reported a lack of consensus on skin care practices, with less than 30% of those interviewed agreeing on how to treat skin breakdown in micro-preemies. As a result, wounds were treated with hydrogen peroxide, exposed to air, or “allowed to heal” without intervention.1
The purpose of this overview is to illuminate key anatomical/structural differences in neonatal skin as it pertains to percutaneous absorption, and tolerance of adhesives to foster anatomically/physiologically based inquiry when selecting prevention and treatment modalities; and to review the evidence for commonly encountered wound types.
References:
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