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surgical wound diastasis

Author(s): Santacroce Morena and De Mola Angela

Published: 28 November, 2021

Case Study

INTRODUCTION

Patient: a 48 year old woman, weight 72 kg, hospitalised 7 November 2019 with an incisional hernia and a past gastric by-pass in laparotomy because of being pathologically overweight (with a diagnosis of median laprocele and an earlier gastro-functional mini by-pass performed through a laparotomy, for pathological obesity). Hiatus hernia, a single cesarean section, gastro-esophageal reflux. Diastasis of the “T” scar of a surgical wound for hernia repair and removal of skin and abdominal tissue as plastic surgery.

Wound: dated 17 December the wound was 3.6 X 4.6. a prurulent bed-sore with erytematous perliesional skin.

Treatment plan: because of its ability to contract the edges of the wound, thus  reducing its size, to stimulate angiogenesis, increase the formation of granulation tissue and reduce edema. It’s application is simple and rapid.
The SNAP system is portable and allows the patient to move as it is worn beneath clothing. It is designed to operate silently, minimising interruptions in sleep.

METHOD:
Initial SNAP therapy: SNAP therapy begun 17.11.19. The sterile field was prepared, proceeding with irrigation using Prontosan with a 30cc syringe and a 20G cannula needle.  We covered the wound with TNT gauze using anatomical tweezers. Then we added polyurethane foam shaped to match the wound bed. A protective product was applied to the perilesional skin and then we applied polyurethane film on the wound sealing it with medication (SNAP TM hydrocolloid)
Then we connected the SNAP therapy cartridge and removed the key of the cartridge.
Finally we fixed the SNAP to the thigh, using the strap provided.

RESULTS

 The SNAP treatment started on 17/12/19 (39° postoperative day). The exudate volume was 130 cc of blood serum liquid. The SNAP was renewed  on 20/12/19. The wound diameter was 3,5  x 4,5 cm. Replacement of SNAP every 4 or 5 days. The wound diameter was 1 x 0,9 cm on 21/01/2020. The exudate volume was 30 cc of blood serum liquid. Removal of SNAP on 26/01/20 with the appearance of reduced wound. On 07/02/2020 the wound had closed.

 

DISCUSSION

Economic evaluation: According to the Hutton and Sheeham studies published in I. Wounds, the Snap could save substantial treatment costs and offer patients more mobility.

CONCLUSION

SNAP therapy system presents ease and practicality guaranteeing patients\’ rest since it is not noisy. Easily manageable even in less compliant patients. In our case the ulcer area responded very well to the application of SNAP .