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TÜRKÇE
Poster - 234
The Role of VAC Therapy and Early Stoma Formation in a Complex Perineal Laceration Following High-Energy Trauma: A Case Report
Fatma Özcan Sıkı, Fatma Betül Yiğit, İsmail Yağmurlu, Numan Kılıçlı, Mehmet Sarıkaya, İlhan Çiftçi
Department of Pediatric Surgery, Selçuk University School of Medicine, Konya, Turkey
Objective:
Effective wound healing in extensive, contaminated soft tissue injuries involving the perineum and sphincter complex following high-energy trauma is particularly challenging. In this case, we aimed to demonstrate the efficacy of negative pressure wound therapy (VAC) and early stoma formation in managing a large perineal wound.
Video Methods and Findings:
A 16-year-old female patient was referred to our center following a motor vehicle accident. She sustained comminuted fractures of the right femur and pelvis, and a deep perineal laceration extending to the anus with associated sphincter injury. Initial primary repair had been performed at an outside hospital without diverting stoma creation, and reduced sphincter tone was noted upon presentation. The repaired perineal wound had dehisced and appeared infected.
During the first operation at our center, a diverting stoma was created. The contaminated perineal wound was debrided, and purulent drainage extending from the pubic region to the lower extremity was drained with placement of surgical drains. The patient underwent repeated surgical debridements of the perineum at regular intervals. Due to insufficient wound healing, negative pressure wound therapy (VAC) was initiated. Following VAC application, granulation tissue formation accelerated, infection was brought under control, and the depth of the wound progressively decreased.
Meanwhile, the orthopedic team performed multiple surgeries, including external fixation and interventions for extremity fractures. Once perineal integrity was restored, the stoma was successfully closed. No fecal incontinence developed.
Conclusion:
In complex perineal injuries, early stoma formation combined with negative pressure wound therapy (VAC) applied by an experienced multidisciplinary team significantly reduces mortality and shortens treatment duration, particularly in cases resulting from high-energy trauma with associated extremity fractures. In contaminated and deep perineal lacerations, VAC therapy provides markedly superior outcomes compared to traditional drainage methods.