Fistula-sparing negative pressure wound therapy in a patient with polytrauma: a case report

Enteroatmospheric fistulas (EAFs) are characterised as an abnormal connection between the gastrointestinal tract and the atmosphere. They present a formidable challenge in surgical practice. Negative pressure wound therapy (NPWT) has become the standard for management of large open abdominal wounds. However, an EAF can make application of this dressing challenging. This case report highlights the authors' experience in managing an EAF-containing large open wound in a 52-year-old male patient following a motorcycle collision. He sustained an 'open-book' pelvic fracture and mesenteric contusions requiring exploratory laparotomy. The patient underwent multiple abdominal surgeries and his abdomen was left open using a temporary abdominal closure device. He had an extended hospital course complicated by a necrotising soft tissue infection requiring large abdominal wall debridement, pelvic hardware infection requiring hardware removal and external fixation, and fascial dehiscence culminating with the development of an EAF. Several iterations of wound care were attempted before succeeding at achieving a fistula-sparing NPWT dressing. Once this was achieved there was rapid improvement in the size of the patient's wound. His wound and overall clinical status continued to improve, with spontaneous resolution of fistula and near complete re-epithelialisation of the wound at eight months. The practice of damage control laparotomy with an open abdomen and temporary abdominal closure devices exposes the bowel to potential damage from iatrogenic serosal injuries, adhesion-induced wall splitting, and serosal irritation from dressing changes. Wound care that minimises soilage of the remainder of the wound from enteric effluent is essential for wound healing. Each wound requires a tailored approach that adjusts for its individual characteristics to ensure optimal patient outcomes.