Abdominal wall defect and enterocutaneous fistula treatment with the vacuum-assisted closure (VAC) system

Reconstructive plastic surgery is frequently required for abdominal wall restoration after defects resulting from necrotizing fasciitis, tumor resection, or wound infection. Crohn's disease is an idiopathic, immunologically mediated disorder of the gastrointestinal tract characterized by segmental, transmural inflammation. Complications include intraabdominal abscess formation and chronic internal and external abdominal fistulas. Crohn's disease complicated by fistula formation is preferably managed surgically by "en bloc" segmental intestine resection.1,2 However, high-output enterocutaneous fistulas may be resistant to surgical management with a loss of large quantities of fluids and resultant metabolic abnormalities. An abdominal wall defect with a high-output enterocutaneous fistula in a patient with Crohn's disease, who had failures in several attempts at surgical closure, was successfully treated with the wound Vacuum-Assisted Closure (V.A.C.) system (Kinetic Concepts, Inc., San Antonio, Texas).