DOI: 10.1097/01.prs.0000278223.62852.ce
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PMID: 17805152
Issn Print: 0032-1052
Publication Date: 2007/09/15
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Excerpt
The term fistula defines an abnormal communication between two epithelialized surfaces. Intestinal fistulas that communicate with the skin are enterocutaneous fistulas.1 Enterocutaneous fistulas remain a challenging clinical problem associated with complicated postoperative courses and long-term disability, particularly in patients with solid or visceral malignancies, gastrointestinal conditions, or a history of multiple abdominal operations.
A previous publication from our institution in 2001 introduced the vacuum-assisted closure system for treating enterocutaneous fistulas as a nonstandard use.2 Since this report, we have applied the system in a series of 15 patients with enterocutaneous fistulas by clinical examination and/or radiographic confirmation. All cases resulted from either postoperative erosion of exposed bowel, bowel erosion through the subcutaneous tissue, or anastomotic leak.
The enterocutaneous fistulas closed if no mucosa was visible in the wound (n = 11); no closure occurred if mucosa was apparent (n = 4). The fistula output did not seem to affect closure rates, and among the fistulas that closed, the mean time to closure was 13 days. Indicators for successful conservative management of enterocutaneous fistulas using the vacuum-assisted closure system seem to be large bowel fistulas and no visible mucosa in the wound.
