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Development of two enteroatmospheric fistulae after split-thickness skin grafting: a case report.

Authors
  • Yin, Jian-Yi
  • Li, You-Sheng
  • Wang, Jian
  • Zhao, Bing-Chao
  • Li, Jie-Shou
Type
Published Article
Journal
Ostomy/wound management
Publication Date
Jun 01, 2013
Volume
59
Issue
6
Pages
48–51
Identifiers
PMID: 23749662
Source
Medline
License
Unknown

Abstract

An enteroatmospheric fistula is a devastating complication in the open abdomen. Usually the fistula forms before the completion of split-thickness skin graft surgery. A 35-year-old woman admitted with pancreatic and liver injuries, and postoperative sepsis underwent open abdomen treatment and developed two enteroatmospheric fistulae 14 days after split-thickness skin grafting. The complication was believed to have occurred as a result of multiple surgical manipulations for intra-abdominal hemorrhage and skin graft dressing changes. One fistula, measuring 0.5 cm in diameter, was managed using a tailored 20-mL syringe, secured to the surrounding tissues with ostomy paste, and a suction catheter. The other fistula, measuring 1.8 cm in diameter, required insertion of a catheter to collect the effluent. Once the effluent was controlled effectively, a second split-thickness skin graft procedure was performed to facilitate fistula management. The patient remained stable until successful fistula repair 8 months later, and she is now awaiting elective abdominal wall reconstruction. This case study is an important reminder that patients with an open abdomen, even after split-thickness skin grafting, are at risk for enteroatmospheric fistula formation. Once this severe complication occurs, effective control of fistula effluent and subsequent split-thickness skin grafting procedures are needed.

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