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The patient then suffered from a complex postoperative course during which she developed an intestinal fistula which freely drained into the wound and gradually led to its complete dehiscence. Her course was further complicated by the surfacing of an enteroatmospheric fistula. This devastating complication was managed by employing the TopClosure Tension Relief system. Using the inverse maturation technique, further described in this report, we were able to progressively approximate and invert the edges of the skin around the enteroatmospheric fistula, thereby facilitating its conversion to an easily manageable stoma. Using this technique, we were able to achieve delayed primary wound closure of a grade 4 open abdomen complicated by an enteroatmospheric fistula in just under 5\u2009weeks\u2019 time.<\/jats:p>","DOI":"10.1136\/bcr-2019-234207","type":"journal-article","created":{"date-parts":[[2020,8,27]],"date-time":"2020-08-27T02:31:07Z","timestamp":1598495467000},"page":"e234207","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Innovative approach to open abdomen: converting an enteroatmospheric fistula into an easily manageable stoma"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3733-9628","authenticated-orcid":false,"given":"Michael Ron","family":"Freund","sequence":"first","affiliation":[{"name":"Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petachia","family":"Reissman","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ram M","family":"Spira","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moris","family":"Topaz","sequence":"additional","affiliation":[{"name":"IVT Medical Ltd, Ra'anana, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,8,26]]},"reference":[{"key":"2025082708202943000_13.8.e234207.1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-009-9996-3"},{"key":"2025082708202943000_13.8.e234207.2","doi-asserted-by":"publisher","DOI":"10.1007\/s00238-011-0671-1"},{"key":"2025082708202943000_13.8.e234207.3","first-page":"48","article-title":"A substitute for skin grafts, flaps, or internal tissue expanders in scalp defects following tumor ablative surgery","volume":"13","author":"Topaz","year":"2014","journal-title":"J Drugs Dermatol"},{"key":"2025082708202943000_13.8.e234207.4","doi-asserted-by":"publisher","DOI":"10.1097\/00000637-199706000-00002"},{"key":"2025082708202943000_13.8.e234207.5","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1007\/s00238-010-0514-5","article-title":"Application of regulated oxygen-enriched negative pressure-assisted wound therapy in combating anaerobic infections\u202f: Oxygen-enriched negative pressure treatment","volume":"34","author":"Topaz","year":"2011","journal-title":"Eur J Plast Surg"},{"key":"2025082708202943000_13.8.e234207.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0039-6109(05)70586-7"},{"key":"2025082708202943000_13.8.e234207.7","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-007-9304-z"},{"key":"2025082708202943000_13.8.e234207.8","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1007\/s00595-014-1020-3","article-title":"Use of a vacuum-assisted closure system for the management of enteroatmospheric fistulae","volume":"45","author":"Tavusbay","year":"2015","journal-title":"Surg Today"},{"key":"2025082708202943000_13.8.e234207.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0039-6109(05)70581-8"},{"key":"2025082708202943000_13.8.e234207.10","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-200208000-00037"},{"key":"2025082708202943000_13.8.e234207.11","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31825c130e"},{"key":"2025082708202943000_13.8.e234207.12","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1097\/TA.0000000000001126","article-title":"What is the effectiveness of the negative pressure wound therapy (NPWT) in patients treated with open abdomen technique? 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