A cautionary note: the use of vacuum-assisted closure systems in the treatment of gastrointestinal cutaneous fistula may be associated with higher mortality from subsequent fistula development.

During the past several years, vacuum-assisted closure (VAC) systems have been increasingly used in the treatment of gastrointestinal cutaneous fistulas, particularly those associated with open abdomen. Recently, I experienced 2 cases in which the original fistula closed after treatment by the VAC system. However, these patients, who had exposed bowel, developed an additional fistula that required surgery. In a recent article from an intestinal-failure unit in the United Kingdom, Rao et al(1) reported on a series of 29 patients treated with VAC, 6 of whom developed new gastrointestinal cutaneous fistulas. Four of these 6 patients died. My own experiences, plus the report of Rao et al,(1) suggest the possibility that the use of the VAC system in patients with exposed bowel and an open abdomen may be associated with subsequent fistula development. Although the numbers are small, it also raises the question that development of a fistula in a patient treated with VAC may result in higher mortality.