Use of negative pressure wound therapy in patient with peritoneal carcinomatosis

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I received a referral from a local surgeon to manage an open surgical wound in a 46 yo patient on whom he had performed emergency surgery for incarcerated ventral hernia. He had put a wound vac on the patient following surgery. Here's my issue: patient has a diagnosis of peritoneal carcinomatosis with unknown primary. He just had an omentectomy and Hipec chemotherapy at the Mayo Clinic (07/31/2023). I have a rule to not vac patients who have metastatic cancer over an area that is involved with the cancer. The peritoneum, fascia and muscle layers were closed at surgery. Wound measurements are 7cm X 3.4cm x 4.7cm- no obvious structures seen in the wound base. Of concern was the appearance of early deep tissue injury on abdominal skin from the wound vac tubing (after only 5 days) I went ahead with the vac, but told the patient that my experience with wound vacs in patients with active cancer receiving this type of treatment is zero. I said I was going to research it and get back to him next week. I plan to talk to Mayo on Monday too, to get their input. What are your thoughts? Thanks

Aug 11, 2023 by Susan J. Cole, MD,

2 replies

Cathy Milne
APRN, MSN, CWOCN-AP

Hi Susan,
My other colleagues can also weigh in on this...but I have one question..did the patient receive radiation therapy in the past to this area? If this is the case, what you might be seeing is minimal tissue tolerance related to the RT. That said, agree with your reluctance in this patient and willingness not to undermine the patient's confidence in the surgeon's treatment plan. More importantly, you have been honest with your patient... you told the patient your experience...and I think it is a valid one (assuming the NPWT was applied appropriately as not to cause tissue damage from the tubing), seeing an issue is disconcerting. I agree with your plan to observe this patient, confident in knowing that you applied the NPWT device yourself and keeping this patient on a short leash. The literature supports that in cases similar to these, NPWT is not an absolute contraindication..https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7949817/.. However, it sounds that the short leash approach clearly individualizes this patient's care

Aug 12, 2023

Susan J. Cole, MD

Thank you very much for your input. I do not think that he has had any radiation treatments. Just traditional chemotherapy and then this Hipec treatment at Mayo. As I understand it, Hipec is chemotherapy that is heated to 102 degrees prior to instillation.

Aug 13, 2023

* Information provided without clinical evaluation and is not intended as a replacement for in-person consultation with a medical professional. The information provided through Curbside Consult is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

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