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Postoperative abdominal wall defects with enterocutaneous fistulae
G A Dumanian1, R Llull, S S Ramasastry
1Division of Plastic Surgery, University of Pittsburgh, Pennsylvania, USA.
Background:
Abdominal wall dehiscence with an associated enterocutaneous fistula is a surgical complication with high morbidity and mortality. Management of the abdominal wall defect is complicated by the continued emergence of liquid bowel contents.
Patients And Methods:
Large abdominal wall wounds of 10 patients with postoperative abdominal wall dehiscence and active enterocutaneous fistulae were managed with early skin grafting directly onto the granulated abdominal viscera.
Results:
Skin graft take averaged 93 +/- 12%, and there were no perioperative complications related to the skin grafting procedure. Overall mortality was 1 out of 10 patients. Enterocutaneous fistula output did not prove overly injurious to the skin grafts. Wound care was simplified in all but 1 patient with fitting of an ostomy appliance.
Conclusion:
Temporary abdominal wall wound closure with skin grafts improved patient comfort and simplified wound care in a staged reconstructive approach to this surgical complication.