Combined management of open abdomen with enteroatmospheric fistula by negative pressure instill wound therapy and dermal matrix wound dressing


COD: 21_06_2021_3636_ep Categorie: , ,

Daniel Sermoneta

Ann Ital Chir, 2021; 10 – July 21
Online Epub

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AIM: The management of open abdomen with enteroatmospheric fistula is a real nightmare for surgeons; negative pressure with fluid instillation is affordable and effective. After improvement of general conditions, a good strategy for promoting tissue granulation around the fistula could be the application of a matrix wound dressing.
MATERIALS AND METHODS: A 45-year-old man was admitted to our Emergency Department for abdominal compartment syndrome following a previous intervention for bowel occlusion; at exploration we found a frozen abdomen that was managed by negative pressure wound therapy with fluid instillation (AbThera® device, VAC Instill®, 3M+KCI).
The condition was complicated by an enteroatmospheric fistula that we managed by negative pressure and fistula diversion according to “Baby Bottle Nipple VAC technique”. After improvement of general and local conditions, in order to obtain a faster reepithalization around the stoma, we decided to apply a dermal substitute (Integra® Bilayer Wound Matrix, LifeSciences Corporation).
RESULTS: We obtained a good reeepithalization and five months after admittance the patient was dismissed in a good health with a stoma bag applied on the fistula. Six month lather bowel continuity was restored.
CONCLUSIONS: The role of negative pressure with instillation in the management of open abdomen is defined; it allows to preserve healthy bowel integrity and to improve septic environment control. If an enteroatmospheric fistula is present, the application of a dermal substitute can be a good strategy for promoting tissue granulation around the fistula, thus allowing the application of a stoma bag and a faster regain of the upright position.