Author: Elizabeth Lupschen, Stomal Therapy, Royal Brisbane Hospital. QLD
This case study examines the use of Eakin Cohesive® Seals as the best solution for hard to manage fistulae
Case A “Mrs W”
77 year old woman with a pre-existing enterocutaneous fistula who underwent a fistula repair and hernia repair with mesh. Following this, her wound dehisced and the fistula recurred.- Wedges of Eakin Cohesive® are used to “picture frame” the wound to provide total skin protection.
- Eakin Cohesive® is layered to fill in dips and creases to prevent leakage.
- Eakin Cohesive® seals are used under and Eakin Wound Pouch to increase wear time (72 hrs)
- Eakin Cohesive® was used in this case study as it was able to withstand high output enteric fluid, due to its dual abilities to absorb fluid and protect the peri fistula skin simultaneously
Mrs W - Photo 3Mrs W - Photo 2Mrs W - Photo 1
Case B “Mr C”
42 year old man with a biliary fistula following a Whipple’s procedure.
Large Eakin Cohesive® seals are adhered to damp granulating skin to provide a dry surface to ‘pouch’ over.
It also allows the granulating skin to heal without coming into contact with caustic bile.
- Eakin Cohesive® is used to fill the creases and dips to prevent leakage on both sides of the fistula.
- An Eakin Cohesive® seal is moulded around the fistula to protect the peri fistula and provide a seal to prevent leakage under the appliance barrier.
The ability of Eakin Cohesive® to absorb moisture allows it to be used around the high output bilary fistula, without leakage for 48 hrs.
Mr C - Photo 2Mr C - Photo 1
Case C “Mrs F”
80 year old woman with an enterocutaneous fistula following a small bowel perforation during the removal of an ovarian cyst.
(A VAC™ dressing was used on this fistula unsuccessfully; a better option was required to provide the patient with a leak free seal, Eakin Cohesive® provided this for the patient).
- At first review the peri fistula skin was excoriated from constant contact with small bowel effluent.
- A Foleys catheter was inserted into the fistula to direct the flow of effluent into the fistula pouch. Despite this, some of the effluent continued to bypass around the catheter and ooze directly onto the peri fistula skin.
- Eakin Cohesive® Seals were used on the skin to provide a ‘dry’ pouching surface, and to heal to peri fistula skin.
- Large Eakin Cohesive® Seals were used to fill in dips and creases to prevent ‘tracking’ of effluent, to protect the peri fistula skin and provide a ‘leak free’ seal.
- Continued use of Eakin Cohesive® on the peri fistula skin allowed the skin to heal remarkably and decrease the size of pouch used.
- The highly absorbent qualities of the Eakin Cohesive® seals used under an Eakin Wound Pouch provided a pouching system that remained intact for 48 hours.
Mrs F - Photo 3Mrs F - Photo 2Mrs F - Photo 1