Enterocutaneous Fistula Isolation and Containment within Complex Abdominal Wounds

Abstract

The effectiveness of negative pressure wound therapy (NPWT) is compromised within an open abdominal wound when there is an enterocutaneous fistula (ECF) draining effluent matter. An innovative method using a silicone, one-piece, compressible isolation device with NPWT with reticulated open cell foam (ROCF) directed effluent into a containment pouch, promoting adherence of NPWT. This approach was used on a 61 year-old with a proctocolectomy, end ileostomy who underwent cytoreductive surgery; 32 year-old with a small bowel perforation with a history or multiple abdominal surgeries; 76 year-old abdominal wall debridement after perforation of small bowel following ventral hernia repair that all developed ECFs in open abdominal wounds. The isolation device and method was used within the SICU and general surgery floors of an Academic medical center located in the Midwest. The ECFs were ineffectively pouched leading to multiple dressing changes several times an hour. Using this method allowed for accelerated wound healing, skin grafting, increase in dressing change interval, accurate output measurements, and eventual ability to pouch ECFs with containment device. The isolation method has been used successfully on moderate-to- high output ECFs that drained into open abdominal wounds to uphold NPWT.  Implementation of this method increased patient mobility, decreased length of need for Total Parenteral Nutrition (TPN), and increased comfort level.