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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.
American Journal of Surgery
|October 1, 1996
Summary
Early skin grafting on abdominal viscera effectively managed abdominal wall dehiscence with enterocutaneous fistulas, simplifying wound care and improving patient comfort in a complex surgical complication.
Area of Science:
- Surgical complications
- Wound healing
- Reconstructive surgery
Background:
- Abdominal wall dehiscence with enterocutaneous fistula presents significant morbidity and mortality.
- Managing these defects is challenging due to continuous bowel content leakage.
Purpose of the Study:
- To evaluate the efficacy of early skin grafting directly onto granulated abdominal viscera for managing large abdominal wall defects with active enterocutaneous fistulae.
Main Methods:
- Ten patients with postoperative abdominal wall dehiscence and active enterocutaneous fistulae underwent early skin grafting directly onto abdominal viscera.
- Ostomy appliances were utilized to manage fistula output and simplify wound care.
Main Results:
- Skin graft take averaged 93%, with no perioperative complications.
- Mortality was 1 in 10 patients; fistula output did not significantly harm grafts.
- Wound care was simplified for most patients.
Conclusions:
- Temporary abdominal wall closure with skin grafts is a viable strategy.
- This approach enhances patient comfort and simplifies wound management.
- It facilitates a staged reconstructive process for complex surgical defects.