The ???Fistula VAC,??? a Technique for Management of Enterocutaneous Fistulae Arising within the Open Abdomen: Report of 5 Cases

Goverman, Jeremy; Yelon, Jay A.; Platz, John; Singson, Rufino C; Turcinovic, Michael

doi:10.1097/01.ta.0000203588.66012.c4

Cited by 101 publications

(94 citation statements)

References 12 publications

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“…Next, black foam with a hole matched to the fistula orifice was placed over it, followed by placement of polyurethane drape and negative pressure of 75 mmHg. Finally, they cut the drape around the fistula and attached an ostomy bag (16). Instead of Xeroform dressing, Byrnes and al.…”

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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Section: Discussionmentioning

confidence: 99%

Enteroatmospheric fistulas - the challenge of the open abdomen

Mutafchiyski

Popivanov

Kjossev

et al. 2015

SSM

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“…200 Where possible, enteral nutrition in patients with an open abdomen should be utilized and may be continued in the majority after abdominal wall closure. 201 A protocolized approach to the use of the VAC device in such patients has provided a high early secondary closure rate, with some 88% of patients being able to be closed between 9-21 days after initial decompression. 202 This compares with earlier reports with standard techniques of less than 50% secondary closure rates where open wounds were eventually skin grafted 203 and where there was a moderate incidence of delayed difficult hernia repair.…”

Section: Surgical Decompressionmentioning

confidence: 99%

Primary Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: Pathophysiology and Treatment

Ap¹,

Wun²,

Chiappa³

et al. 2015

Emerg Med Open J

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Abdominal Compartment Syndrome (ACS) is a potentially lethal condition caused by various events that produce intra-abdominal hypertension. The most common cause is blunt abdominal trauma. Increasing intra-abdominal pressure causes progressive hypoperfusion and ischemia of the intestines and other peritoneal and retroperitoneal structures. Pathophysiological effects include release of cytokines, production of oxygen free radicals, and decreased cellular formation of adenosine triphosphate. These processes may lead to translocation of bacteria from the gut and intestinal edema, predisposing patients to multiorgan dysfunction syndrome. The consequences of abdominal compartment syndrome are profound and affect many vital body systems. Respiratory, hemodynamic, cardiovascular, renal, and neurological abnormalities are signs of abdominal compartment syndrome. Medical management of critically ill patients with raised intra-abdominal pressure should be instigated early to prevent further organ dysfunction and to avoid progression to ACS. Many treatment options are available and are often part of routine daily management in the ICU (nasogastric, rectal tube, prokinetics, enema, sedation, body position). Some of the newer treatments are very promising options in specific patient populations with raised IAP. Nursing care involves vigilant monitoring for early detection, including serial measurements of intra-abdominal pressure.KEYWORDS: Intra-abdominal hypertension; Abdominal compartment syndrome; Damage control laparotomy; Laparostomy; Open abdomen. DEFINITIONS, INCIDENCE AND MEASUREMENT STRATEGIES IN INTRA-ABDOMINAL HY-PERTENSION (IAH) AND ABDOMINAL COMPARTMENT SYNDROME (ACS)The concept of the Abdominal Compartment Syndrome (ACS) has been rediscovered as a final common pathway of the physiologic sequelae of increased Intra-Abdominal Pressure In each case if the graph shifts to the right, higher IAP and lower APP values may not be associated with significant end-organ dysfunction creating a degree of "ACS-resistance." Shifts to the left would create "ACS-sensitivity" where lower values of IAP (higher APP values) may still be associated with organ dysfunction which might not occur normally. This results in difficulty for broader acceptance of critical IAP and APP levels for individual cases. ACS-sensitivity may potentially occur in patients where there is pre-existing partial end-organ failure, morbid obesity or following fluid hyper-resuscitation in patients with severe burns, haemorrhagic pancreatitis, massive blood loss, widespread intra-peritoneal sepsis and high-output intestinal fistulae. 6-8There is no strict definition of what represents abnormal IAP, but there is a general acceptance that measured pressures >12 mmHg when recorded 1-6 hours apart are considered to represent IAH, where Sugrue, et al. have shown that this represents up to 40% of cases admitted to a surgical Intensive Care Unit (ICU). 9 Although there are biases in the prospective assessment of a selective population admitted to an ICU who ...

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“…Concomitant electrolyte abnormalities can lead to secondary effects ranging from cardiac arrhythmias to renal failure. Accurate measurement of the effluent is essential to help guide the fluid and nutritional needs in these often sick patients [7].…”

Section: Allow Accurate Measurement Of Effluentmentioning

confidence: 99%

Effluent Control in Enterocutaneous Fistula – Experience Of an Enterostomal Therapist

Nirmal¹,

Therapist²

2017

IOSR JNHS

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The ???Fistula VAC,??? a Technique for Management of Enterocutaneous Fistulae Arising within the Open Abdomen: Report of 5 Cases

Abstract: Application of the fistula-VAC should be considered a useful option in treating patients with intestinal fistulae in open abdominal wounds.

Cited by 101 publications

References 12 publications

Enteroatmospheric fistulas - the challenge of the open abdomen

Enteroatmospheric fistulas - the challenge of the open abdomen

Primary Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: Pathophysiology and Treatment

Effluent Control in Enterocutaneous Fistula – Experience Of an Enterostomal Therapist

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