A Novel Technique To Skin Graft Abdominal Wall Wounds Surrounding Enterocutaneous Fistulas

Abstract

Enterocutaneous fistulas often are associated with large abdominal wall wounds. Successful skin grafting of these sites is difficult, as the bed is constantly bathed by enteric contents. A method to graft these sites successfully would provide an important advance in their treatment. The medical records of patients undergoing skin grafting of a site around an enterocutaneous fistula were reviewed. The amount of fistula output at the time of grafting was recorded. The method of grafting, as well as the means of protecting the graft from enteric exposure, were noted. Skin grafts were evaluated for the extent of "take." Seven patients met the inclusion criteria. After 1-2 weeks, the graft take was 90% in three patients, 80% in two patients, and 50% in two patients. After 1 month, there was complete epithelialization in 85% of patients, and the remaining patient had most of the site epithelialized. This healing allowed placement of an ostomy appliance in all patients. The fistula output was >400 mL per day in 70% of the patients. Multiple techniques were used to divert enteric flow away from the graft, but the most common was placement of a negative pressure dressing that concomitantly secured the graft and allowed enteric diversion. The presence of a high-output enterocutaneous fistula does not preclude successful skin grafting. Such grafting can accelerate wound healing as well as improve skin and site hygiene by allowing the placement of an ostomy device.