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      A novel method for managing enterocutaneous fistulae in the open abdomen using a pedicle flap

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      Journal of Surgical Case Reports
      JSCR Publishing Ltd

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          Abstract

          A significant proportion of patients with severe intra-abdominal sepsis are managed by leaving the peritoneal cavity open in an attempt to control the infective process, regardless of aetiology. However, a considerable number of these patients develop enterocutaneous fistulae, which compound the clinical situation and delay closure of the peritoneal cavity. We propose a new method of dealing with such fistulae, by simply fashioning a direct pedicle flap to patch the fistulous opening. This method allows control of the fistula and facilitates early closure of the abdomen.

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          Staged management of giant abdominal wall defects: acute and long-term results.

          Shock resuscitation leads to visceral edema often precluding abdominal wall closure. We have developed a staged approach encompassing acute management through definitive abdominal wall reconstruction. The purpose of this report is to analyze our experience with this technique applied to the treatment of patients with open abdomen and giant abdominal wall defects. Our management scheme for giant abdominal wall defects consists of 3 stages: stage I, absorbable mesh insertion for temporary closure (if edema quickly resolves within 3-5 days, the mesh is gradually pleated, allowing delayed fascial closure); stage II, absorbable mesh removal in patients without edema resolution (2-3 weeks after insertion to allow for granulation and fixation of viscera) and formation of the planned ventral hernia with either split thickness skin graft or full thickness skin closure over the viscera; and stage III, definitive reconstruction after 6-12 months (allowing for inflammation and dense adhesion resolution) by using the modified components separation technique. Consecutive patients from 1993 to 2001 at a single institution were evaluated. Outcomes were analyzed by management stage, with emphasis on wound related morbidity and mortality, and fistula and recurrent hernia rates. Two hundred seventy four patients (35 with sepsis, 239 with hemorrhagic shock) were managed. There were 212 males (77%), and mean age was 37 (range, 12-88). The average size of the defects was 20 x 30 cm. In the stage I group, 108 died (92% of all deaths) because of shock. The remaining 166 had temporary closure with polyglactin 910 woven absorbable mesh. As visceral edema resolved, bedside pleating of the absorbable mesh allowed delayed fascial closure in 37 patients (22%). In the stage II group, 9 died (8% of all deaths) from multiple organ failure associated with their underlying disease process, and 96% of the remaining 120 had split-thickness skin graft placed over the viscera. No wound related mortality occurred. There were a total of 14 fistulae (5% of total, 8% of survivors). In the stage III group, to date, 73 of the 120 have had definitive abdominal wall reconstruction using the modified components separation technique. There were no deaths. Mean follow-up was 24 months, (range 2-60). Recurrent hernias developed in 4 of these patients (5%). The staged management of patients with giant abdominal wall defects without the use of permanent mesh results in a safe and consistent approach for both initial and definitive management with low morbidity and no technique-related mortality. Absorbable mesh provides effective temporary abdominal wall defect coverage with a low fistula rate. Because of the low recurrent hernia rate and avoidance of permanent mesh, the components separation technique is the procedure of choice for definitive abdominal wall reconstruction.
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            The floating stoma: a new technique for controlling exposed fistulae in abdominal trauma.

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              Diagnostic and therapeutic fistuloscopy: an adjuvant management in postoperative fistulas and abscesses after upper gastrointestinal surgery.

              Postoperative fistulas and abscesses pose difficult management problems. We report our experience in the use of fistuloscopy in postoperative fistulas and abscesses after upper gastrointestinal surgery.
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                Author and article information

                Journal
                J Surg Case Rep
                J Surg Case Rep
                jscr
                jscr
                Journal of Surgical Case Reports
                JSCR Publishing Ltd
                2042-8812
                1 June 2012
                June 2012
                : 2012
                : 6
                : 5
                Affiliations
                Redcliffe Hospital, Queensland, Australia
                Article
                10.1093/jscr/2012.6.5
                3862462
                04329845-62c2-4862-933b-e8824d3f4c32
                © JSCR
                History
                Categories
                Colorectal Surgery
                040

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