The Progressive Pligmologist: Case Study September 2025

This friendly patient is a male in his late 50s, who presented as an emergent transfer with severe ischemic cardiomyopathy due to a heart attack, and who required ECMO support and transition to an LVAD (left ventricular assist device) to allow his heart to recover. Unfortunately, after his procedure he required resection of a segment of necrotic bowel sustained during his LVAD placement, and as a consequence of this needed creation of an ostomy. Due to the subsequent nutritional failure during his hospitalization and obesity, he suffered a dehiscence of his midline abdominal incision, i.e., in two separate locations his incision split.

The first consideration was placement of negative pressure wound therapy, or a wound vac. However, these devices are contraindicated in spaces that have continuity to internal cavities of the body, and this patient’s breakdown was over an exposed, deeper tissue incision in the abdominal cavity wall. As a consequence, we started routine home health visits with the recommendation to pack his dehiscence sites with hydrofera blue classic to promote slough management. We also recommended very high protein intake to compensate for the weight lost during his hospitalization.

With a transition to collagen and use of an abdominal binder, we noted gradual closure and healing of his incisional breakdown. As of his last visit, his LVAD was functioning well, without any concerns for infection related to the driveline, and he developed a robust scar. He still hopes that there might be an option for ostomy reversal once his nutrition status is fully optimized.