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September 1992

Surgical Treatment of Enteric 'Bud' Fistulas in Contaminated WoundsA Riskless Extraperitoneal Method Using Split-thickness Skin Grafts

Author Affiliations

From the Department of Surgery, University of California, Irvine, and the Surgical Service, Long Beach (Calif) Veterans Administration Medical Center.

Arch Surg. 1992;127(9):1027-1031. doi:10.1001/archsurg.1992.01420090031005

• 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.

(Arch Surg. 1992;127:1027-1031)