Using a bio-scanner and 3D printing to create an innovative custom made approach for the management of complex entero-atmospheric fistulas

Virginia Durán Muñoz-Cruzado,José Tinoco González,Felipe Pareja Ciuró,Juan Carlos Puyana,Andrés Padillo Eguía,Javier Padillo-Ruiz,Luis Tallón Aguilar,Francisco José Calero Castro

doi:10.1038/s41598-020-74213-7

Abstract

Enteroatmospheric fistulae are challenging clinical conditions that require surgical expertise and that can result in chronic debilitating conditions placing the patient in a vicious cycle characterized by non healing wounds and malnutrition. They are a complex entity that presents great variability depending on the number, shape, and size of the fistulous orifices, their debit, and the dimensions of the wound. This means that, at present, there is no device that adapts to the anatomical characteristics of each patient and manages to control the spillage of intestinal effluvium from the wound. The aim of this study is to describe the manufacturing technique and to assess the preliminary results of a custom device designed through bioscanner imaging and manufactured using 3D printing for use with negative pressure wound therapy (NPWT) in the management of enteroatmospheric fistula. A proof of concept is given, and the design of the device is presented for the first time. After obtaining images of each fistula with a bioscanner, a personalised device was designed for each patient by 3D printing shape of a prism and a hollow base, taking into account the dimensions of the fistulous area in order to perform a floating ostomy to isolate the wound from the debit enteric. The polycaprolactone (PCL) device was placed including inside the fistulous surface and surrounding it with the NPWT system in order to accelerate wound healing.

Highlights

Enteroatmospheric fistula is defined as the communication between the intestinal lumen and the surface of an open abdominal w ound[1,2,3,4,5,6]
The local control of the fistula presents a wound care challenge due to the enormous variability of this entity: the size of the wound, the position and number of fistulous orifices, intestinal segments involved, and the volumen of intestinal output, etc. These many factors result in complex management challenges and currently, due to the great anatomical variability of these fistulae there is not a unique device or solution that can be used to ensure adequate local control in this very heterogenous complication. typical of complex enteroatmospheric fistulae
This therapy must be accompanied by a device that is capable of isolating the fistulous orifice of the negative pressure wound therapy (NPWT), since if negative pressure is produced on the fistula, it would have untoward consequences and perpetuating and even enlarge the fistulous surface

Summary

Introduction

Enteroatmospheric fistula is defined as the communication between the intestinal lumen and the surface of an open abdominal w ound[1,2,3,4,5,6]. The ideal treatment is resection of the intestinal segment involved and an anastomosis with the reconstruction of the abdominal w all[1,2,4] This treatment is not feasible at the time of diagnosis due to the peritoneal adhesions presented by the patients and the inflammation of the surrounding tissues; there is bridge therapy that is used for externalisation of intestinal fluids to avoid continuous contact with the wound, favouring the correct healing and granulation of the wound until definitive surgery can be p erformed[1,2,4]. Different techniques have been described to isolate the wound from the faecal material and to provide correct granulation of the wound by combining NPWT with various devices that help establish a “floating stoma”[4]

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Conclusion