Surgical treatment of enteric 'bud' fistulas in contaminated wounds. A riskless extraperitoneal method using split-thickness skin grafts
I. J. Sarfeh and J. G. Jakowatz
Department of Surgery, University of California, Irvine.
We describe methods and results of a local extraperitoneal method of
repairing enterocutaneous "bud" fistulas in abdominal-wall defects. The
method is performed with local anesthesia and involves an extraperitoneal
closure with skin-graft coverage. Of the nine fistulas so treated, five
healed. No patient's postoperative course was set back by the repairs that
failed since the method precludes intraperitoneal entrance. Two of three
high-output fistulas were successfully repaired with the extraperitoneal
method, reversing an otherwise stormy clinical course. We conclude that for
epithelialized enterocutaneous fistulas, little is lost if our method of
repair fails and much is gained if it is successful in these critically ill
patients.
