Fascia-to-Fascia Closure with Abdominal Topical Negative Pressure for Severe Abdominal Infections: Preliminary Results in a Department of General Surgery and Intensive Care Unit

Abstract

In our brief experience, VAFC-KCI(®) seems to be associated with a high fascial closure rate. The complexity of the management of abdominal source control has a role in the success of primary fascial closure. The VAFC-KCI(®) system seems to contribute positively in fascia-to-fascia abdominal closure in cases of severe abdominal infection, in particular when early surgical source control is obtained.

Application of negative pressure wound therapy in patients with wound dehiscence after abdominal open surgery: a single center experience

“…In the present study, the results of peritoneal bacterial cultures were positive in 36 patients (72%), and as previously reported, when intra-abdominal infection is identified, source control and the appropriate use of antibiotics are essential [17]. Recently, various reports have described the effective management of abdominal wounds with intra-abdominal infection by NPWT, and have attributed this success to infection control and wound closure [4,16]. In the present study, the unsuccessful closure group had a significantly greater proportion of deep and complex wounds than the successful closure group (P = 0.005).…”

“…Recently, NPWT has been applied in the abdominal surgery field for temporary closure in cases of trauma and bowel strangulation, and to manage abdominal compartment syndrome when the abdomen is open [14,15]. Batacchi et al [6], in a prospective study, found that the time to wound closure and intensive care unit stay in a NPWT group were shorter than in a Bogota bag group, and in another study, fascia-to-fascia closure was successfully achieved by applying an abdominal topical negative pressure in a patient with an intra-abdominal infection [16]. The majority of our 50 patients had profuse fluid drainage through the main wound caused by postoperative seroma or a partial fascial defect.…”

Open Abdomen Management of Intra-Abdominal Infections: Analysis of a Twenty-Year Experience

“…Despite progress following the introduction of vacuum-assisted temporary closure of the abdominal wall [1,22,23], the mortality associated with OA remains high, with many co-morbidities related apparently to the management and timing of delayed fascial closure [24]. At present, the literature contains varying proposals for whether or not to close the abdominal cavity after a laparotomy, with some preferring the use of an OA technique and others preferring repeat laparotomy if circumstances demand this [21].…”

Options for Closure of the Infected Abdomen

“…In a study of patients with abdominal compartment syndrome and a definitive source of infection, primary fascial closure rates were 100% when early infection control was obtained compared with 40% when source control was delayed [15]. Similarly, the mean duration of open abdomen was significantly longer with delayed source control (34.2 vs. 8.5 d; p < 0.005) [15].…”

“…In a study of patients with abdominal compartment syndrome and a definitive source of infection, primary fascial closure rates were 100% when early infection control was obtained compared with 40% when source control was delayed [15]. Similarly, the mean duration of open abdomen was significantly longer with delayed source control (34.2 vs. 8.5 d; p < 0.005) [15]. Compared with other techniques, including zipper closure, the silastic sheet ''silo,'' and loose packing (among others), VAC yielded the highest rates of fascial closure and the lowest mortality rate [16].…”