title: Development of two enteroatmospheric fistulae after split-thickness skin grafting: a case report.
abstract: An enteroatmospheric fistula is a devastating complication in the open abdomen. Usually the fistula forms before the completion of split-thickness skin graft surgery. A 35-year-old woman admitted with pancreatic and liver injuries, and postoperative sepsis underwent open abdomen treatment and developed two enteroatmospheric fistulae 14 days after split-thickness skin grafting. The complication was believed to have occurred as a result of multiple surgical manipulations for intra-abdominal hemorrhage and skin graft dressing changes. One fistula, measuring 0.5 cm in diameter, was managed using a tailored 20-mL syringe, secured to the surrounding tissues with ostomy paste, and a suction catheter. The other fistula, measuring 1.8 cm in diameter, required insertion of a catheter to collect the effluent. Once the effluent was controlled effectively, a second split-thickness skin graft procedure was performed to facilitate fistula management. The patient remained stable until successful fistula repair 8 months later, and she is now awaiting elective abdominal wall reconstruction. This case study is an important reminder that patients with an open abdomen, even after split-thickness skin grafting, are at risk for enteroatmospheric fistula formation. Once this severe complication occurs, effective control of fistula effluent and subsequent split-thickness skin grafting procedures are needed.
authors.affiliation: Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China.
authors.forename: Jian-Yi
authors.initials: JY
authors.lastname: Yin
authors.forename: You-Sheng
authors.initials: YS
authors.lastname: Li
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.forename: Bing-Chao
authors.initials: BC
authors.lastname: Zhao
authors.forename: Jie-Shou
authors.initials: JS
authors.lastname: Li
mesh_terms: D000328:Adult; D005260:Female; D005402:Fistula / Q000209:etiology* / Q000628:therapy; D006801:Humans; D016038:Skin Transplantation / Q000009:adverse effects*