A Creative “Fistula-Vac” Technique in Management of Open Abdomen with Multiple Entero-atmospheric Fistulas: A Case-report

Introduction: The open abdomen (OA) is an important approach for managing intra-abdominal catastrophes and continues to be the standard of care. Despite this, challenges are associated with high incidence of complications and poor outcomes. Moreover, entero-atmospheric fistula (EAF) adds difficulties to management through wound bed effluent-contamination which increases the morbidity and mortality rate. Breaking the cycle of tissue inflammation, infection, and sepsis, resulting from enteric contents leakage, should be a major goal in approach to these complex patients. Fistula-VAC method affords wound bed with all vacuum-therapy benefits besides diverting enteric content into an ostomy-appliance over fistulas. This study presents a fully- healed complex case of OA with multiple juxtaposed EAFs at wound bed center which make its management more challenging. Case-presentation: A ۳۵-year-old man developed a vertical wound from epigastric to hypogastric areas of abdominal-wall divisions due to bowl perforation and adhesions following appendectomy with multiple high-output (۲-۳ liters/day) EAFs were refractory to medical therapy. this method was used to control fistulas-effluent and mature wound bed then he went under bowl-reconstruction surgery. The work was reported with the CARE ۲۰۲۳ criteria. Methods and Materials: Wounds were first cleaned with saline irrigation and VAC sponge was tailored to precisely fit wound bed without overlapping skin. Two holes were cut in sponge to match enteric openings. Then, high-elasticity substance (cleft-palate teat ring) were put within holes to exclude fistulas and facilitate reestablishment sealing with placement of vacuum- assisted closure. The sponge covered by polyurethane drape subsequently to apply ۱۰۵ mm Hg continuous negative pressure. Lastly, the stoma-appliance and bag were placed over fistulas and connected to a Foley bag to allow for gravity drainage. The fistula-VAC was changed every ۵ days. Results: The fistula-VAC creates a barrier between the open abdominal wound bed and the enteric opening via confluent negative pressure, resulting in complete isolation of the fistula and diversion of enteric contents into the ostomy bag and gravity drainage system. The patient had full intestinal drainage diversion using fistula-VAC after the first dressing-application. Healthy granulation tissue surrounding the enteric fistula ensued in patient by the end of first session. After ۵-session fistula-VAC wound size reduced

کلیدواژه ها:

Fistula-Vac ، open abdomen ، entero-atmospheric fistulas ، vacuum-therapy ، ostomy-appliance ، negative pressure