Day in the life


Each issue of Wounds International features a typical day in the life of a different wound care clinician from around the world. This series looks at the variety of techniques that are required in different settings and asks clinicians about the type of conditions they work in, the types of wounds they see and the challenges that they face when providing wound care to patients.


T


his issue features the staff at the gastrointestinal fistula division at Jinling Hospital in China.


Can you outline where you practice? Jinling Hospital is a tertiary hospital affiliated with Nanjing University in China. Jinling Hospital has 1,700 beds, which includes 250 beds for the Research Institute of General Surgery. The gastrointestinal division was


set up in the early 1970s starting with only six beds. Now we have 56 beds, of which 17 are in the ICU. More than 300 patients with complicated gastrointestinal fistulae are referred from other hospitals in China annually.


Can you explain the make-up of your team? Our team includes three attending surgeons, 10 residents, eight research fellows and 54 nurses who all work under the guidance of Emeritus Professor Li Jieshou, who started the gastrointestinal fistula division. Postgraduate students are also


trained in our division. There are three postdoctoral research fellows who are studying how to prevent surgical site infection, surgical complications affected by Crohn’s disease and metabolic intervention of sepsis.


What types of wounds do you regularly see? The most frequent fistulae we see are postoperative and trauma-related. Fistulae complicated with Crohn’s disease and radiation therapies have been increasing recently. We also treat classic cases of enterocutaneous, intestinal tract and early uncontrolled cavity fistulae.


What are the main types of equipment, dressings and techniques that you use on a day-to-day basis? Performing irrigation, sump drainage and wound dressing changes forms the majority of our everyday work. Soft polypropylene mesh is sometimes used in patients with severe intra- abdominal infections.


What is the most unusual wound you have seen recently and how did you manage it? We recently had a female patient with a recurring spontaneous fistula. When she was hospitalised, she had already undergone three operations for an ileocolic anastomotic fistula. We performed an ileocolic anastomosis resection after controlling the intra-abdominal infection. However, the fistula repeatedly reoccurred even though the patient was on immunosuppressive drugs. Last month, she was readmitted


to the hospital for a rectal-vaginal fistula, two months after her ileocolic resection. We continued to manage the condition with enteral nutrition and immunosuppressive drugs.


Do you feel your practice has any unique obstacles that hamper your work? Working a lot of overtime is the main problem for us. We are a busy facility and need more surgeons. Further education for surgeons


about the management of gastrointestinal fistulae is also necessary. Appropriate control of sepsis and bleeding, resuscitation and organ support can prevent early fistulae from developing into


The staff in the gastrointestinal fistula division at Jinling Hospital in China.


complicated and severe cases, saving energy and time.


What equipment/resource/ education would make the most difference to your everyday work? Sump drainage is simple and an ideal procedure for the control of intra- abdominal infection. However, vacuum-assisted dressing


systems could help us drain fistulae and promote the rapid closure of open abdomens. Organ support equipment such


as ventilators, haemodialysis and Molecular Adsorbents Recirculation System (MARS) would help us save more patients with severe gastrointestinal fistulae. Shared experiences with other


centres improve our understanding of how to manage gastrointestinal fistulae. Increasing education about the cause and prevention of gastrointestinal fistulae will also help us to reduce their occurrence.


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