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  • Author: Natawat Narueponjirakul x
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Supparerk Prichayudh, Eakkaluck Thammacharoen, Suvit Sriussadaporn, Rattaplee Pak-art, Sukanya Sriussadaporn, Kritaya Kritayakirana, Pasurachate Samorn and Natawat Narueponjirakul



An enteroatmospheric fistula (EAF) is a devastating complication of abdominal surgery. EAF wound care is uniformly problematic and burdensome because the fistula effluent is difficult to contain, causing several abdominal skin problems.


To report the case of a complex EAF in a patient in whom conventional wound care techniques failed to contain the fistula.


We reviewed the patient’s medical records and the novel wound care technique used to contain the fistula.


We report the use of a modified vacuum-assisted closure (VAC) technique, the “Wall VAC”, for the wound care of a patient with a complex EAF having large and multiple fistula openings following multiple abdominal operations. The Wall VAC technique consists of (1) leveling the skin surrounding the EAF wound, (2) creating the Wall VAC using a rectangular-shaped VAC sponge with 2 suction systems, and (3) sealing the system with a plastic bag and incise drape. By using this technique, the fistula effluent was effectively contained and the abdominal skin was well protected. The system changed every 3 to 4 days.


Our modified VAC technique, the “Wall VAC”, is simple and effective in containing a large volume (3,000 to 4,000 mL) of fistula effluent and protecting the abdominal skin in a patient with a complex EAF. We recommend this particular technique as an alternative method for managing a complex EAF.