Case Report Successful control of high-flow output enterocutaneous fistula wound with an innovative self-manufactured plug

Wei-Jie Chen, Hao Guo, Ge Chen, Wei-Bin Wang, Tai-Ping Zhang
2017 Int J Clin Exp Med   unpublished
Meticulous wound care is necessary for relieving the suffering of enterocutaneous fistula (ECF) patients and improving the quality of life. Although many approaches to treat the fistula wound have been attempted, wound care before definitive surgery remains a challenge, especially for high-flow output ECF. Cases: In the present study, we report a case of a 77-year-old female with a diagnosis of jejunal fistula 14 days after the Miles surgery. The traditional vacuum assisted closure (VAC) device
more » ... was initially applied to the patient's wound care. However, the residual enteric fluid out from the fistula irritated skin and brought great pain (Visual Analogue Score 8). Morphine (20-30 mg daily) was used. Besides, the VAC system was replaced nearly every day because skin exudation led to poor airtightness and the evacuation tube was often blocked. In the following month, the wound size didn't change significantly. To reduce bowel fluid irritation and promote wound healing, we established a self-manufactured plug to occlude the fistula, collect enteric fluid, and protect the wound. The patient did not complain any severe discomfort. No pain killer was used any more (Visual Analogue Score 3). The catheter of the plug collected 500-800 ml enteric fluid per 24 hours without blockade. In addition, all the materials to make the plug are cheap and available in the wards. After approximately 2 weeks of regular wound dressing changes, the fistula wound formed scabs and healed well. Conclusions: We present a case of successful control of high-flow output enterocu-taneous fistula wound using an innovative self-manufactured plug. We highly recommend this pain-relieving and cost-effective approach for fistula wound care.