Biological dressings for the management of enteric fistulas in the open abdomen - A preliminary report

Hypothesis: Biological dressings can be effective tools in the management of enteric fistulas, which are the nemesis of exposed viscera. Design: Retrospective review of medical records. Setting: University-affiliated level I trauma center. Patients: Patients with open abdominal cavities and co-existent intestinal fistulas who were treated between January 1, 1999, and July 1, 2006. Interventions: Application of biological dressings to fistula sites within open abdominal cavities during serial fascial closure. Biological dressings included cadaveric skin, human acellular dermal matrix, and fibrin sealant. Main Outcome Measures: Enteric fistula closure and healing of the abdominal wound. Results: During the 6 years under review, there were 69 patients with open abdomens. Of these patients, 7 (10%) developed enteric fistulas and underwent application of biological dressings. In 5 patients, fistulas closed and the abdominal wound healed after application of biological dressings. One additional patient healed after fistula resection. Biological dressing treatment and fistula resection both failed in 1 patient. There was no morbidity or mortality attributable to the intervention. Conclusions: Intestinal fistulas significantly complicate the management of patients with open abdomens. In this case series, biological dressings were effective in achieving fistula closure. A prospective multi-institutional study is required to confirm these preliminary encouraging results.