The Use of Dehydrated Human Umbilical Cord Allograft in the Treatment of Enterocutaneous Fistulas: A Unique Case

Background: An enterocutaneous fistula (ECF) is an abnormal connection that develops between the intestinal tract and the skin. Wound care management of ECF is challenging and results are often unsuccessful. Dehydrated human umbilical cord (dHUC) allograft is a minimally manipulated, dehydrated, non-viable cellular allograft for homologous use that provides a protective environment for the healing process. 

Methods: We present a unique case of a 62-year-old male who developed 3 ECFs and was treated with dHUC allograft. The patient initially underwent elective orthopedic surgery for lumbar stabilization. During surgery, multiple complications developed and subsequently, the patient became paraplegic requiring reoperation to treat an ischemic sigmoid colon with perforation and needed a proximal diverting colostomy. The patient went on to develop 3 ECFs located on the mid-abdominal wall. A dHUC allograft was cut into strips the size of the fistula. Using a curette, the fistula edges were debrided removing all epithelial tissue. Bleeding was controlled with silver nitrate and electric cautery. A 3-0 nylon suture was used to secure the allograft into the fistula tract by placing the suture into the fistula edging, then the dHUC, and finally through the opposite side of the fistula tract. The suture was gently tightened by pulling it upwards with use of a parachute technique and securing the allograft down into the fistula tract. The two ends of the suture were secured with a surgical knot and a few drops of saline were applied to the allograft which was covered with Adaptic and a foam dressing.

Results: This technique was repeated weekly for three weeks. Two of the fistulas closed. The third fistula required two additional applications of dHUC to close. All fistulas healed within 3 months and have remained closed.

Conclusion: The application of dHUC allograft was successful in closing ECFs without surgical intervention.