Anatomy-based surgical strategy of gastrointestinal fistula treatment

Turégano, Fernando; Marín, Andrés García

doi:10.1007/s00068-011-0103-8

Cited by 7 publications

(5 citation statements)

References 36 publications

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“…Some papers 14–16 present images of enterocutaneous fistulas taken from CT. However, when combining CT slices to form a volumetric body, the resolution of the wound surface is lost.…”

Section: Discussionmentioning

confidence: 99%

“…The first clinical results of the application of this therapy have been widely described by Durán Muñoz-Cruzado et al 13 from our working group, which corroborates the efficacy and safety of the application of the device generated by the methodology presented in this work. Some papers [14][15][16] present images of enterocutaneous fistulas taken from CT. However, when combining CT slices to form a volumetric body, the resolution of the wound surface is lost.…”

Section: Treatment Effectivenessmentioning

confidence: 99%

See 1 more Smart Citation

Personalized additive manufacturing of devices for the management of enteroatmospheric fistulas

Calero Castro,

Padillo Eguía,

Durán Muñoz‐Cruzado

et al. 2023

Bioengineering & Transla Med

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Additive manufacturing techniques allow the customized design of medical devices according to the patient's requirements. Enteroatmospheric fistula is a pathology that benefits from this personalization due to its extensive clinical variability since the size and morphology of the wound differ extensively among patients. Standard prosthetics do not achieve proper isolation of the wound, leading to a higher risk of infections. Currently, no effective personalized technique to isolate it has been described. In this work, we present the workflow for the design and manufacture of customized devices adapted to the fistula characteristics as it evolves and changes during the treatment with Negative Pressure Wound Therapy (NPWT). For each case, a device was designed with dimensions and morphology depending on each patient's requirements using white light scanning, CAD design, and additive manufacturing. The design and manufacture of the devices were performed in 230.50 min (184.00–304.75). After the placement of the device, the wound was successfully isolated from the intestinal content for 48–72 h. The therapy was applied for 27.71 ± 13.74 days, and the device was redesigned to adapt to the wound when geometrical evolutionary changes occur during the therapy. It was observed a decrease in weekly cures from 23.63 ± 10.54 to 2.69 ± 0.65 (p = 0.001). The fistulose size was reduced longitudinal and transversally by 3.25 ± 2.56 cm and 6.06 ± 3.14 cm, respectively. The wound depth also decreased by 1.94 ± 1.08 cm. In conclusion, customization through additive manufacturing is feasible and offers promising results in the generation of personalized devices for the treatment of enteroatmospheric fistula.

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“…Some papers 14–16 present images of enterocutaneous fistulas taken from CT. However, when combining CT slices to form a volumetric body, the resolution of the wound surface is lost.…”

Section: Discussionmentioning

confidence: 99%

Section: Treatment Effectivenessmentioning

confidence: 99%

Personalized additive manufacturing of devices for the management of enteroatmospheric fistulas

Calero Castro,

Padillo Eguía,

Durán Muñoz‐Cruzado

et al. 2023

Bioengineering & Transla Med

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show abstract

“…dressing. In small and superficial EAFs without visible mucosa, suture with subsequent coverage of the suture line with fibrin glue, acellular dermal matrix or autologous split skin graft may be successful without any additional risks (15,44). Jamsidi et al reported 5/7 EAFs closed in this way (71.4%) (18).…”

Section: Discussionmentioning

confidence: 99%

Enteroatmospheric fistulas - the challenge of the open abdomen

Mutafchiyski

Popivanov

Kjossev

et al. 2015

SSM

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INTRODUCTION:In the past two decades, the open abdomen (OA) technique has gained wide popularity as an effective approach in the cases with severe peritonitis, abdominal compartment syndrome and critical trauma. However, it is still associated with high complication rate. Enteroatmospheric fistulas are the most devastating complication. Despite the numerous techniques described in the literature, their management remains a challenging task.

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“…In this case, it is difficult for the skin to overlap the margins of the intestinal perforation so as to cover and close it. According to the literature [6], the best way to transform the fistula tract is when it is in a kind of ''well,'' where the bowel lies at least 2 cm below skin level and is surrounded by granulation tissue, so that musculocutaneous/subcutaneous and cutaneous circumferential tissues can coalesce, reduce, and cover the defect. When the fistula is very deep, the patient is fed parenterally, and, provided that the bowel is not obstructed, good healing and closure take place almost spontaneously.…”

Section: Discussionmentioning

confidence: 99%