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Improvised vacuum assisted closure dressing for enterocutenous fistula, a case report.

ABSTRACT:

Introduction

Management of enterocutaneous fistula is challenging with high morbidities and mortalities despite the recent advances in surgical technique. The bad outcomes are a result of associated metabolic complications. Vacuum-assisted closure dressing for the management of enterocutaneous fistula is a relatively new technique with benefit as a bridge to definitive surgery or definitive management in achieving spontaneous closure at a shorter time. In the current report, we share our experience of improvising vacuum-assisted closure dressing for managing postoperative enterocutaneous fistula and achieving spontaneous closure PRESENTATION OF CASE: We describe a case of a 56-year-old male from Tanzanian with a postoperative discharge of intestinal contents from the wound. He was diagnosed to have a proximal enterocutaneous fistula. After sepsis control and achieving hemodynamic stability, the enterocutaneous fistula was managed with parenteral nutrition, proton pump inhibitors, anti-cathartics, and somatostatin analogs. Endoscopic therapies and fibrin sealants are other described nonoperative interventions for enterocutaneous fistula. The unavailability of these modalities limited us. Vacuum-assisted closure dressing was improvised using gauze pieces, feeding tube, and Op-site dressings at a pressure of -30 mmHg. We achieved spontaneous closure of the proximal enterocutaneous fistula in 32 days.

Discussion

The time to closure was within the range of 12-90 described for conventional vacuum assisted closure dressing, and there were no complications. Close monitoring of improvised VAC dressings is required as the risks are unknown; however, given the known complications of conventional VAC dressing, a risk of hemorrhage and creation of entero-atmospheric fistula exists.

Conclusion

Improvised VAC dressing for ECF is potentially an acceptable option with promising outcomes in low-resource settings.

SUBMITTER: Nyamuryekunge MK

PROVIDER: S-EPMC7708767 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Improvised vacuum assisted closure dressing for enterocutenous fistula, a case report.

Nyamuryekunge Masawa K MK Yango Biswalo B Mwanga Ally A Ali Athar A

International journal of surgery case reports 20201123

<h4>Introduction</h4>Management of enterocutaneous fistula is challenging with high morbidities and mortalities despite the recent advances in surgical technique. The bad outcomes are a result of associated metabolic complications. Vacuum-assisted closure dressing for the management of enterocutaneous fistula is a relatively new technique with benefit as a bridge to definitive surgery or definitive management in achieving spontaneous closure at a shorter time. In the current report, we share our ...[more]

PMID: 33395857

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Project description:Background and Objectives: The tie-over bolster technique has been conventionally used for skin graft fixation; however, long operative times and postoperative pain are the main disadvantages of this method. In this study, we introduce a new method using vacuum-assisted closure (VAC) with a silicon-based dressing as an alternative for skin graft fixation. This retrospective study aimed to evaluate the clinical effect of the VAC plus silicon-based dressing method and the conventional tie-over bolster technique for skin graft fixation in terms of pain, operative time, and skin graft take rate. Materials and Methods: Sixty patients who underwent skin graft surgery performed by a single surgeon from January 2017 to October 2018 were included in this clinical study. They were divided into two groups based on the type of treatment: tie-over bolster technique and vacuum-assisted closure (VAC), or silicon-based dressing groups. The operative times were recorded twice (during suturing or stapling of the graft and during removal of the dressing) in the two groups; similarly, pain was assessed using a numeric rating scale (NRS) after surgery and during dressing removal. Skin graft take rate was evaluated two weeks after dressing removal. Results: Twenty-six patients who met the eligibility criteria were enrolled into the study and assigned to one of the two groups (n = 13 each). No significant differences in age, gender, and graft area were noted between the two groups of patients. The VAC plus silicon-based dressing group demonstrated higher skin graft take rates (p < 0.05), shorter operation times (p < 0.05), and lower levels of pain (postoperative pain and pain during dressing removal) compared with the tie-over bolster technique group (p < 0.05). Conclusions: These findings indicate that VAC with silicon-based dressing can be used for skin graft fixation due to its superior properties when compared with the conventional method, and can improve the quality of life of patients undergoing skin graft fixation.

Dataset Information

Improvised vacuum assisted closure dressing for enterocutenous fistula, a case report.

Introduction

Discussion

Conclusion

Publications

Improvised vacuum assisted closure dressing for enterocutenous fistula, a case report.

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