The "Fistula VAC," a technique for management of enterocutaneous fistulae arising within the open abdomen: report of 5 cases.
BACKGROUND
Management of intestinal fistulae in open abdominal wounds remains a significant clinical challenge for those caring for patients surviving damage control abdominal operations. Breaking the cycle of tissue inflammation, infection, and sepsis, resulting from leakage of enteric contents, should be a major goal in the approach to these complex patients. We describe a technique utilizing vacuum assisted closure (VAC) which achieves control of enteric flow from fistulae in open abdominal wounds.


METHODS
The fistula-VAC is fashioned from standard sponge supplies, negative pressure pumps, and ostomy appliances. The fistula-VAC was changed every three days prior to split thickness skin grafting, and every five days following grafting.


RESULTS
Five patients underwent application of the fistula-VAC. All patients had complete diversion of enteric contents. This enteric diversion allowed for successful skin grafting in all patients.


CONCLUSIONS
Application of the fistula-VAC should be considered a useful option in treating patients with intestinal fistulae in open abdominal wounds.
Goverman
Jeremy
J
From the North Shore University Hospital, North Shore-Long Island Jewish Health System, Manhasset, New York, USA.
Yelon
Jay A
JA
Platz
John Joseph
JJ
Singson
Rufino C
RC
Turcinovic
Michael
M
D003125:Colostomy / Q000379:methods; D003161:Compartment Syndromes / Q000209:etiology; D004867:Equipment Design; D004868:Equipment Failure; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods; D007412:Intestinal Fistula / Q000209:etiology / Q000517:prevention & control*; D007813:Laparotomy / Q000009:adverse effects; D008297:Male; D018579:Patient Selection; D017592:Skin Care / Q000379:methods; D016038:Skin Transplantation; D013396:Suction / Q000295:instrumentation / Q000379:methods*; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D007507:Therapeutic Irrigation; D016896:Treatment Outcome; D014945:Wound Healing