| Abstract | HYPOTHESIS: Biological dressings can be effective tools in the management of enteric fistulas, which are the nemesis of exposed viscera. DESIGN: Retrospective review of medical records. SETTING: University-affiliated level I trauma center. PATIENTS: Patients with open abdominal cavities and coexistent intestinal fistulas who were treated between January 1, 1999, and July 1, 2006. INTERVENTIONS: Application of biological dressings to fistula sites within open abdominal cavities during serial fascial closure. Biological dressings included cadaveric skin, human acellular dermal matrix, and fibrin sealant. MAIN OUTCOME MEASURES: Enteric fistula closure and healing of the abdominal wound. RESULTS: During the 6 years under review, there were 69 patients with open abdomens. Of these patients, 7 (10%) developed enteric fistulas and underwent application of biological dressings. In 5 patients, fistulas closed and the abdominal wound healed after application of biological dressings. One additional patient healed after fistula resection. Biological dressing treatment and fistula resection both failed in 1 patient. There was no morbidity or mortality attributable to the intervention. CONCLUSIONS: Intestinal fistulas significantly complicate the management of patients with open abdomens. In this case series, biological dressings were effective in achieving fistula closure. A prospective multi-institutional study is required to confirm these preliminary encouraging results. |
| Authors | Ramin Jamshidi, William P Schecter
(Affiliation: Department of Surgery, San Francisco General Hospital and University of California, San Francisco, CA 94110, USA.)
|
| Journal | Archives of surgery (Chicago, Ill. : 1960)
(Arch Surg)
Vol. 142
Issue 8
Pg. 793-6
(Aug 2007)
ISSN: 0004-0010 United States |
| PMID | 17724853
(Publication Type: Journal Article)
|
| Topics |
- Abdominal Injuries
(complications, pathology, surgery)
- Adult
- Aged
- Biological Dressings
- Female
- Follow-Up Studies
- Humans
- Intestinal Fistula
(etiology, therapy)
- Male
- Middle Aged
- Retrospective Studies
- Treatment Outcome
- Wound Healing
- Wounds, Penetrating
(complications, pathology, surgery)
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