title: Intra-abdominal pedicled rectus abdominis muscle flap for treatment of high-output enterocutaneous fistulae: case reports and review of literature.
abstract: Despite advances in nutritional supplementation, sepsis management, percutaneous drainage and surgical technique, enterocutaneous fistulae remain a considerable source of morbidity and mortality. Use of adjunctive modalities including negative pressure wound therapy and fibrin glue have been shown to improve the rapidity of fistula closure; however, the overall rate of closure remains poor. The challenge of managing chronic, high-output proximal enterocutaneous fistulae can be successfully achieved with appropriate medical management and intra-abdominal placement of pedicled rectus abdominis muscle flaps. We report two cases of recalcitrant high output enterocutaneous fistulae that were treated successfully with pedicled intra-abdominal rectus muscle flaps. Indications for pedicled intra-abdominal rectus muscle flaps include persistent patency despite a reasonable trial of non-operative intervention, failure of traditional operative interventions (serosal patch, Graham patch), and persistent electrolyte and nutritional abnormalities in the setting of a high-output fistula.
authors: Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
authors: Joseph N
authors: JN
authors: Carey
authors: Clifford C
authors: CC
authors: Sheckter
authors: Andrew J
authors: AJ
authors: Watt
authors: Gordon K
authors: GK
authors: Lee
mesh_terms: D000328:Adult; D017577:Cutaneous Fistula / Q000601:surgery*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000601:surgery*; D008297:Male; D017568:Rectus Abdominis / Q000601:surgery*; D013524:Surgical Flaps
keywords: Enterocutaneous fistula; Pedicled flap; Rectus abdominis