Vacuum-assisted closure therapy in patients with large postoperative wounds complicated by multiple fistulas

Vacuum-assisted closure (VAC) therapy is a widely acknowledged method for chronic and traumatic wound healing.The feasibility of VAC therapy used for the treatment of intestinal fistulas is still a subject of debate. Complex postoperativewounds pose significant therapeutic problems, especially when there are several fistula openings in thewound area and other sites, usually at the site of previous drains. This paper describes the treatment of three patientsin a critical condition, with complex postoperative wounds complicated by multiple fistulas. Vacuum-assisted closuretherapy was based on effective drainage of the biggest fistula opening and ensuring conditions promoting the healingprocess of other fistulas and the wound. A considerable improvement in general condition and wound healing wasnoted within 2-4 weeks and both the number of fistulas and the volume of excreted contents decreased. After 5-7weeks a significant improvement in wound healing was observed in all patients. Once the general condition of allpatients was considered satisfactory (2-6 months), they underwent surgery aimed at restoration of the digestive tractcontinuity.In our opinion, VAC therapy used for the treatment of postoperative wounds with multiple fistulas in thewound area and other sites should aim mainly at the improvement of patients’ general condition, limitation of thenumber of fistulas as well as accelerated wound healing. This may lead to formation of one stoma-type fistula, whichcan be dressed and cared for by patients until the continuity of the digestive tract has been surgically restored.