title: Vacuum Assisted Closure (VAC) therapyTM as a swiss knife multi-tool for enteric fistula closure: tips and tricks: a pilot study.
abstract: OBJECTIVE
  Enterocutaneous fistulas (ECFs) are an uncommon surgical problem, but they are characterized by a difficult management. Vacuum-assisted closure (VAC) therapy is a method utilized for chronic and traumatic wound healing. At first, VAC therapy had been contraindicated in the treatment of intestinal fistulas, but as time went by, VAC therapy revealed itself to be a "Swiss knife multi-tool". This paper presents some clinical cases of enterocutaneous (ECF) and enteroatmospheric fistulas (EAF) treated with VAC therapy™.
  
  
  METHODS
  The history of 8 patients treated for complex fistulas was revised. Four of them presented with enterocutaneous and four with enteroatmospheric fistulas. All were treated with VAC therapy with variations elaborated to help in accelerated closure of intestinal wall lesions.
  
  
  RESULTS
  Four out of four ECFs closed spontaneously. In the EAF group, in three cases the fistula turned slowly into an entero-cutaneous fistula, and in one out of four it closed spontaneously. The mean length of VAC therapy™ was 35.5 days and that of spontaneous closure was 36.4 days.
  
  
  CONCLUSIONS
  The results of our study encourage the use of VAC therapy™ for the treatment of enterocutaneous fistulas. VAC therapy™ use has a double therapeutic value: (1) it promotes the healing of the skin and allows also the management of EAFs; (2) in selected cases, those in which it is possible to create a deep fistula tract ("well") it is possible to assist to a complete healing with closure of the ECFs.
authors.affiliation: Emergency Surgery Unit, Department of Surgery, Catholic University of the Sacred Heart, Gemelli Polyclinic, Rome, Italy. gildapepe@yahoo.it.
authors.forename: G
authors.initials: G
authors.lastname: Pepe
authors.forename: S
authors.initials: S
authors.lastname: Magalini
authors.forename: C
authors.initials: C
authors.lastname: Callari
authors.forename: R
authors.initials: R
authors.lastname: Persiani
authors.forename: C
authors.initials: C
authors.lastname: Lodoli
authors.forename: D
authors.initials: D
authors.lastname: Gui
mesh_terms: D000328:Adult; D000368:Aged; D017577:Cutaneous Fistula / Q000628:therapy*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D010865:Pilot Projects; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult