Negative pressure wound therapy for prolonged surgical wound healing after brachiobasilic arteriovenous fistula creation in a patient with end-stage liver failure

Author:

Takai Kanako1ORCID,Saeki Maki2,Takaoka Seiji3,Tada Yusuke1,Fujimura Ryuta3,Harada Tamaki3,Yamauchi Takashi4,Kumano Hodaka1

Affiliation:

1. Department of Critical Care Medicine, Higashiosaka City Medical Center, Higashiosaka, Osaka Prefecture, Japan

2. Nursing Department, Higashiosaka City Medical Center, Higashiosaka, Osaka Prefecture, Japan

3. Department of Nephrology, Higashiosaka City Medical Center, Higashiosaka, Osaka Prefecture, Japan

4. Department of Cardiovascular Surgery, Higashiosaka City Medical Center, Higashiosaka, Osaka Prefecture, Japan

Abstract

A 54-year-old male patient diagnosed with hepatorenal syndrome caused by decompensated alcoholic cirrhosis was referred for arteriovenous fistula (AVF) creation after initiation of hemodialysis. A brachiobasilic arteriovenous fistula (BBAVF) was created because neither forearm had suitable vasculature. Large-volume serous effusion from the incision persisted postoperatively, and we started negative pressure wound therapy (NPWT) for wound protection. The effusion volume decreased gradually; however, up to 80 ml of discharge continued daily. Re-operation was performed 35 days after the initial operation, followed by continued NPWT. The wound was almost healed 85 days after the primary surgery. We present a case of severe surgical wound complication after AVF creation in a patient with hemostatic and coagulation disorders and malnutrition caused by end-stage hepatic failure. We confirmed the usefulness of NPWT for excessive surgical wound effusion and the adequacy of BBAVF for vascular access.

Publisher

SAGE Publications

Subject

Nephrology,Surgery

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