Background: Enterocutaneous fistulas (ECFs) are a challenging problem that may complicate the postoperative course of patients with solid or visceral abdominal cancers or those having undergone multiple abdominal surgeries. Uncontrolled ECFs can lead to or worsen existing malnutrition and macerate surrounding skin and soft tissues, making wound healing and closure more difficult. Purpose: To review our experience with the use of vacuum assisted closure (VAC) in the treatment of recalcitrant ECFs. Methods: Over an 8 month period, VAC was used in 9 patients (M:F=5:4) ages 32-72 (average=60.1±4.8, mean±sem) years with ECFs following abdominal surgery. Four patients had advanced malignancy (i.e. pancreatic, N=2; metastatic gastric, N=1; cervical, N=1). Four patients had diabetes. All patients were malnourished (average albumin=2.2±0.2 mg/dl, range 1.4-3.4 mg/dl). VAC treatment averaged 21.1±5.2 (9-32) days. Results: Complete closure of 3 ECFs was achieved with VAC treatment alone while an additional ECF was surgically closed 16 days following VAC treatment. Among the 4 ECFs that closed, patient albumin averaged 1.97±0.47 mg/dl and the two diabetics had well controlled blood sugars (< 140). Among the 5 patients that did not close, their albumin averaged 2.34±0.30 mg/dl and the 2 diabetics had persistantly elevated blood sugars (> 140). Control of fistulous drainage was obtained in 6 patients with decreased inflammation and excoriation of surrounding skin and decreased ECF output. Failure to obtain control in 3 patients was due to difficulty maintaining a vacuum seal around ostomies and patient noncompliance. Conclusion: VAC is a helpful adjunct in managing selected complicated ECFs. It can simplify dressing changes, control fistulous drainage, serve as a bridge to surgical repair, and even result in fistula closure. Albumin levels did not predict closure while good control of blood sugars was associated with ECF closure.
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