Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
J Plast Reconstr Aesthet Surg. 2013 Aug;66(8):1145-8. doi: 10.1016/j.bjps.2012.12.008. Epub 2013 Jan 11.
Despite advances in nutritional supplementation, sepsis management, percutaneous drainage and surgical technique, enterocutaneous fistulae remain a considerable source of morbidity and mortality. Use of adjunctive modalities including negative pressure wound therapy and fibrin glue have been shown to improve the rapidity of fistula closure; however, the overall rate of closure remains poor. The challenge of managing chronic, high-output proximal enterocutaneous fistulae can be successfully achieved with appropriate medical management and intra-abdominal placement of pedicled rectus abdominis muscle flaps. We report two cases of recalcitrant high output enterocutaneous fistulae that were treated successfully with pedicled intra-abdominal rectus muscle flaps. Indications for pedicled intra-abdominal rectus muscle flaps include persistent patency despite a reasonable trial of non-operative intervention, failure of traditional operative interventions (serosal patch, Graham patch), and persistent electrolyte and nutritional abnormalities in the setting of a high-output fistula.
尽管在营养补充、脓毒症管理、经皮引流和手术技术方面取得了进展，但肠外瘘仍然是发病率和死亡率的重要来源。辅助治疗方法（包括负压伤口治疗和纤维蛋白胶）的应用已被证明可以提高瘘管闭合的速度；然而，总的闭合率仍然很低。通过适当的医疗管理和腹腔内放置带蒂腹直肌肌瓣，可以成功治疗慢性、高流量的肠外瘘。我们报告了两例顽固的高流量肠外瘘病例，通过带蒂腹腔内腹直肌肌瓣治疗取得了成功。带蒂腹腔内腹直肌肌瓣的适应证包括：尽管进行了合理的非手术干预尝试，但仍持续通畅；传统手术干预（浆膜贴片、Graham 补丁）失败；高流量瘘管持续存在电解质和营养异常。
