Wall vacuum-assisted closure technique for a complex enteroatmospheric fistula: report of a case

Abstract

Background: An enteroatmospheric fistula (EAF) is a devastating complication of abdominal surgery.EAF wound care is uniformly problematic and burdensome because the fistula effluent is difficult to contain,causing several abdominal skin problems. Objectives: To report the case of a complex EAF in a patient in whom conventional wound care techniques failedto contain the fistula. Methods: We reviewed the patient's medical records and the novel wound care technique used to containthe fistula. Results: We report the use of a modified vacuum-assisted closure (VAC) technique, the VAC, for the woundcare of a patient with a complex EAF having large and multiple fistula openings following multiple abdominaloperations. The Wall VAC technique consists of (1) leveling the skin surrounding the EAF wound, (2) creatingthe Wall VAC using a rectangular-shaped VAC sponge with 2 suction systems, and (3) sealing the system with aplastic bag and incise drape. By using this technique, the fistula effluent was effectively contained and theabdominal skin was well protected. The system changed every 3 to 4 days. Conclusions: Our modified VAC technique, the VAC, is simple and effective in containing a large volume(3,000 to 4,000 mL) of fistula effluent and protecting the abdominal skin in a patient with a complex EAF. Werecommend this particular technique as an alternative method for managing a complex EAF. Keywords: Enteroatmospheric fistula, negative pressure wound therapy, vacuum-assisted closure, wall VAC