Biological dressings for the management of enteric fistulas in the open abdomen: a preliminary report.

HYPOTHESIS Biological dressings can be effective tools in the management of enteric fistulas, which are the nemesis of exposed viscera. DESIGN Retrospective review of medical records. SETTING University-affiliated level I trauma center. PATIENTS Patients with open abdominal cavities and coexistent intestinal fistulas who were treated between January 1, 1999, and July 1, 2006. INTERVENTIONS Application of biological dressings to fistula sites within open abdominal cavities during serial fascial closure. Biological dressings included cadaveric skin, human acellular dermal matrix, and fibrin sealant. MAIN OUTCOME MEASURES Enteric fistula closure and healing of the abdominal wound. RESULTS During the 6 years under review, there were 69 patients with open abdomens. Of these patients, 7 (10%) developed enteric fistulas and underwent application of biological dressings. In 5 patients, fistulas closed and the abdominal wound healed after application of biological dressings. One additional patient healed after fistula resection. Biological dressing treatment and fistula resection both failed in 1 patient. There was no morbidity or mortality attributable to the intervention. CONCLUSIONS Intestinal fistulas significantly complicate the management of patients with open abdomens. In this case series, biological dressings were effective in achieving fistula closure. A prospective multi-institutional study is required to confirm these preliminary encouraging results.