The use of the Flexi-Seal Faecal Management System in laparostomy wounds involving enterocutaneous fistula

Abstract

We present an innovative application of the Flexi-Seal Faecal Management System (FMS) for the diversion of upper and lower gastrointestinal secretions from enterocutaneous fistulae associated with complex wounds. Fistula is a common complication after the formation of a laparostomy, secondary to cases of severe intra-abdominal sepsis, acute mesenteric ischaemia, necrotising infection of the abdominal wall, or intra-abdominal hypertension. A significant mortality rate is associated with such fistula. With the successful continent diversion of gastrointestinal secretions by the Flexi-Seal FMS, abdominal wounds can be successfully skin-grafted, and wound healing expedited.

Figure 1

(A) A granulating abdominal wound, secondary to laparostomy, with a gastrocutaneous fistula (arrowed). (B) The application of a Flexi-Seal® FMS to the fistula (arrowed) and skin graft dressed with paraffin gauze and polyurethane foam. (C) The skin graft at the first wound check (day 5), with continent diversion of secretions with the FMS. (D) The graft at day 13, with successful adherence of a stoma bag to the grafted tissue.