Biological Dressings for the Management of Enteric Fistulas in the Open Abdomen

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Abstract
The open abdomen is a common iatrogenic surgical condition in the modern intensive care unit. An open peritoneal cavity promotes drainage of infection, relieves abdominal hypertension, allows repeated access to the abdomen for reevaluation and lavage, and allows damage control surgery in unstable patients requiring resuscitation and delayed anatomical reconstruction. While prospective studies1,2 have failed to demonstrate significant outcome improvement with this strategy, use is widespread because of increasing recognition of the inadequacy of other techniques. The use of open abdomen management has a number of associated complications, including wound infection, ventral hernia, and intraperitoneal abscess.3-5 However, the nemesis of open abdomen management is a hole in the exposed bowel without overlying soft tissue, referred to as an “enteroatmospheric fistula.”6-9