PMC3835275_01
The fistula after disintegration of the biological mesh and exposing healthy granulation tissues prior to skin grafting and 'stoma' formation (A). A split skin graft was used to cover the granulated area and the elevated inferior lip of skin was rotated as a flap (B). The edges of the fistula were sutured to the skin graft and flap to form a 'stoma' to which a stoma bag can be applied.
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Because the wound around the fistula was granulating well after the disintegration of the biological mesh (Figure 1A), the EAF was converted to a 'stoma' by the application of split-skin skin graft over the granulating area and suturing the fistula edges to skin (Figure 1B).
Abdominal CT scan showing several cuts of the abdominal hernia prior to the definitive corrective surgery. The large hernia had a wide-neck and contained small and large bowels (A-C). The fistula ('stoma') opening site is demonstrated clearly in (D).
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Preoperative nutritional status was adequate and CT evaluation showed a hernia containing large and small bowels (Figure 2).
The 'stoma' as it looked some 6 months after the initial injury and prior to the final definitive procedure.
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The abdomen revealed skin excoriation at the inferior aspect of the 'stoma' (Figure 3).
Operative view showing the 'stoma'-bearing small bowel after releasing hernia contents, division of all adhesions, and adequate fistula mobilization. This 'stoma'-bearing segment was then resected and a stapled side-to-side anastomosis was fashioned.
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The fistula-bearing small bowel segment (Figure 4) was then resected, and bowel continuity was restored by a stapled side-to-side anastomosis.