Complex Abdomen Specialist Regions Hospital Scandia, MN
Wounds near fistulas and ostomies are typically not good candidates for skin grafting due to the risk of effluent contamination; however, not grafting these wounds can delay healing and further tax patients and providers with finding creative ways to manage the wound and intestinal effluent. Furthermore, these wound types can many times leave the patient bound to a care facility, with further skin breakdown related to effluent leakage resulting in cellulitis and readmission to an acute care hospital. In this case series, we describe the use of fistula isolation devices (FIDs*) to help manage intestinal effluent during the placement of skin grafts or artificial skin substitutes onto nearby wounds. FIDs were placed onto 4 patients (1 female and 3 males) ranging in age from 44- to 81-years of age. Comorbidities included type 2 diabetes mellitus, vascular disease and coagulation disorders, and cancer. Upon fistula isolation, skin grafts were placed onto the nearby wounds of three patients, while the other patient received a xenograft to help cover the nearby wound. All grafts were covered with non-adherent dressings and bolstered using negative pressure wound therapy (NPWT) at -125mmHg for 5-10 days, and NPWT dressings were changed every 5 days. FIDs effectively helped seal the fistula effluent away from the newly placed grafts, and excellent graft take and wound healing occurred for all four patients. Ultimately, peri-fistula skin was fully healed, and each patient was transitioned to a standard ostomy pouch system for effluent management. Results from these cases suggest that FIDs can be applied to patients for effective effluent management, thereby allowing skin grafting to a nearby wound. Skin grafting can allow formation of intact skin around enteric fistulas and ostomies, which could allow providers to transition patients to standard ostomy appliances.