Peristomal leakage of enteroatmospheric fistulas treated with lipotransfer combined to minimal-invasive scar release technique

Abstract

Lipografting is emerging as a "rescue" treatment for postoperative sequelae, soft tissue volume defects and refractory fistulas. After complicated laparotomies or colostomies, also peristomal soft tissue volume deficiencies and scarring can occur and lead to severe care problems. Currently, no satisfactory treatment is available for these sequelae resulting in general surgery. In this case report, we applied the operative approach by means of a minimal-invasive scar release combined to waterjet-assisted lipotransfer and sculpturing on the abdominal wall as a treatment of peristomal irregularities. We applied one procedure on a patient with insufficient stoma sealing on large enteroatmospheric fistulas in "frozen" open abdomen (Björk 4 classification). Clinical and aesthetic outcome were measured and evaluated via digital photographs and CT scan pre- and postoperatively. Size reduction, complete sealing of the stoma appliance and total healing of the peristomal skin damage were accomplished within 5 weeks.

Level of Evidence: Level V, therapeutic study.

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