Clinical Case Series: Management of Four Patients with Complicated Enterocutaneous Fistula using pouching system in conjunction with negative pressure therapy in a Long Term Acute Care Facility (LTAC)

Clinical Case Series:
Management of Four Patients with Complicated Enterocutaneous Fistula using pouching system in conjunction with negative pressure therapy in a Long Term Acute Care Facility (LTAC).

Problem:  Four patients with high output enterocutaneous fistula (EF) were treated in a LTAC.  Patient A developed EF post gastric by-pass surgery.  Patient B with history of Crohn’s disease, developed three post-operative EF.  Patient C with history of radiation treatments for cervical cancer and ventral hernia developed EF.  Patient D status post motorcycle accident with torso evisceration had an attempted surgical flap but later developed EF under flap.

Past Management:  Patient A was managed with foam NPWT* complicated with foam embedded in granulation tissue.  Patient B was managed with foam NPWT*.  Patient C was managed with dry dressing complicated with contact dermatitis.  Patient D was managed with dry dressing and wall suction.

Current Management:  Patient A had applied fistula device** with drain NPWT±.  Patient B was managed with foam NPWT* then changed to fistula device** with drain NWPT± when foam NPWT* could not manage large volume drainage.  Patient C was managed with fistula device** with drain NPWT±.   Patient D had a large wound that was divided for management.  The left side had collagen dressing±±, silver hydrofiber§, and gauze with drain NPWT±.  A wall was built using strip paste§§, hydrocolloid‡ and drape‡‡.  The right side of wound had fistula device** applied with drain NPWT±.

Outcome:  Patient A had maximum wear of four weeks and 98.9% wound volume reduction but discharged home with dry gauze for insurance reasons.  Patient B had maximum wear of three weeks and 88.6% wound volume reduction and discharged home with fistula pouch† with drain NPWT±.   Patient C had maximum wear of one week with goal of containment only with no wound volume reduction expected.  Patient D had maximum wear of one week and wound volume reduction of 98.9%.

Conclusion:  Drain NPWT± combined with fistula device** is an effective option for EF management.

*KCI Wound Vac
** Coloplast Fistula and Wound Management System
±Smith and Nephew EZ-Care with Wooding Scott drain
±±Johnson & Johnson Fibracol Plus
§Convatec Aquacel AG
§§Coloplast Strip Paste
‡Hollister Flextend Skin Barrier
‡‡Smith & Nephew Transparent Adhesive Dressing
†Convatec Eakin Fistula and Wound Pouch