177-183 Sobotka:03 Di Cosmo

© SINPE-GASAPE ABSTRACT: Background: Abdominal catastrophe, suture leakage and wound dehiscence are serious complications of surgical procedures. Wound infection is a frequent complication and the mortality is high due to long and difficult treatment procedures. Treatment is often difficult as a result of fistula formation, presence of necrotic and infected tissue, and complex surgical management. Long-term nutritional support is necessary between treatment periods. We have developed a new healing system which is based on the combination of hyaluronan and iodine. This system has been successfully used in our department for more than 4 years. The aim of this observational study was to assess the effect of this complex in subjects with abdominal catastrophe. Methods: Seven patients with multiple fistulas and extensive wound dehiscence were admitted to our metabolic care unit. Total parenteral nutrition (TPN) providing full coverage of nutritional needs was used in all cases until full recovery of oral nutrition. After removal of necrotic tissue the wounds were dressed once daily with sterile gauze soaked in hyaluronate-iodine complex (Hyiodine®). Intestinal fistula secretions were drained using negative pressure. After wound granulation and improvement of patient condition (no sooner than after 2 months) the intestinal fistulas were resected and intestinal continuity established. Then, when primary suture was impossible, the hyaluronan-iodine complex was again used for healing of the open abdominal wound. Results: TPN and hyaluronan-iodine treatment led to significant wound healing in all patients. Within 14 days all wounds were dirt free and covered with granulation tissue. After 3.3±0.9 months, patients were operated on (fistula resection and anastomosis). The abdominal wall was not closed surgically in 4 patients during fistula resection. However, local treatment with hyaluronaniodine complex led to complete wound healing in all patients within 4-10 weeks. Conclusions: We obtained excellent results with the sodium hyaluronate-iodine complex in combination with TPN in the treatment of complicated abdominal wounds. We presume this effect is related to the combination of immune cell activation, angiogenic properties, and a strong affinity of hyaluronate to water together with the antimicrobial effect of iodine. (Nutritional Therapy & Metabolism 2008; 26: 177-83)