IFLYSIB   05383
INSTITUTO DE FISICA DE LIQUIDOS Y SISTEMAS BIOLOGICOS
Unidad Ejecutora - UE
artículos
Título:
Effect of intestinal pressure on fistula closure during vacuum assisted treatment: a computational approach
Autor/es:
CATTONI DIEGO; RAVAZZOLA CONSTANZA; TÜNGLER VICTORIA; WAINSTEIN DANIEL EDGARDO; CHARA OSVALDO
Revista:
International Journal of Surgery
Editorial:
Elsivier
Referencias:
Año: 2011 vol. 9 p. 662 - 668
ISSN:
1743-9191
Resumen:
Background
Enterocutaneous
fistulae, pathological communications between the intestinal lumen and
the abdominal skin, can arise as serious complication of
gastrointestinal surgery. A current non-surgical treatment for this
pathology involves topical application of sub-atmospheric pressure, also
known as vacuum assisted closure (VAC). While this technique appears to
be promising, surgeons report a number of cases in which its
application fails to achieve fistula closure. Here, we evaluate the
fistula?s physical properties during the vacuum assisted closure process
in a computational approach exploring the relevance of intraluminal
intestinal pressure.
Methods
A
mathematical model formulated by differential equations based on tissue
elasticity properties and principles of fluid mechanics was created and
forcing functions were integrated to mimic intestinal pressure
dynamics. A software to solve equations and to fit the model to
experimentally obtained data was developed. This enabled simulations of
vacuum assisted fistula closure under different intestinal pressure.
Results
The
simulation output indicates conditions, in which fistula closure can or
cannot be expected suggesting favoured or impeded healing,
respectively. When modifications of intestinal pressure, as observed in
fistula accompanying pathologies, are integrated, the outcome of fistula
closure changes considerably. Rise of intestinal pressure is associated
with delay of fistula closure and temporary fistula radius
augmentation, while reduction of intestinal pressure during
sub-atmospheric pressure treatment contributes to a faster and direct
fistula closure.
Conclusion
From
the model predictions, we conclude that administration of intestinal
pressure decreasing compounds (e.g. butylscopolamine, glucagon) may
improve VAC treatment, while intestinal pressure increasing drugs should
be avoided.