Ovine forestomach matrix as a novel adjunct to promote healing of low output enterocutaneous fistulae in high-risk surgical patients

The development of enterocutaneous fistulas (ECF) after emergency laparotomies is not uncommon. Management is difficult and options limited. Studies suggest ovine forestomach matrix (OFM) grafts may be viable treatment options for complex wounds. The goal of this study was to investigate the use of OFM in the treatment of ECFs. Patients with ECFs as a result of emergency laparotomy were treated with OFM. Wounds were appropriately debrided and OFM was applied. A secondary dressing was applied and left on for a minimum of 7 days. Patients were followed at regular intervals to monitor progression of wound healing. Three patients were included in the case series. One patient developed ECF after bowel resection secondary to gunshot wounds. OFM was applied and upon follow up, the wound was significantly healed. The second patient developed ECF after bowel resection secondary to being struck by a vehicle. OFM was applied and at two week follow up the fistula was closed. The third patient developed ECF after major small bowel resection secondary to acute mesenteric ischemia. OFM was applied and the ECF was fully closed at one month. This case series highlights the utilization of OFM to augment wound healing in patients with ECFs. This pilot study demonstrates the excellent results achieved with OFM as an adjunct for difficult wounds such as ECFs with the ability to accelerate healing. • OFM was applied to complex wounds with low-output enterocutaneous fistulas. • All patients achieved over 90% wound closure after OFM treatment. • OFM use led to fistula closure without adverse events in high-risk patients. • The preserved matrix supported healing and tissue regrowth. • OFM shows promise as a wound healing adjunct after emergency surgery.