Management of the open abdomen: clinical recommendations for the trauma/acute care surgeon and general surgeon

Fernández, Luis G.

doi:10.1111/iwj.12655

Cited by 18 publications

(12 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…10,11 Much is published about the closure of the open abdomen; the majority are temporizing procedures that often accept an incisional hernia. 12,13 At our institution, frequent use of the ABRA DTS has resulted in a paradigm shift toward definitive primary myofascial closure. The ABRA DTS provides dynamic tension that facilitates relaxation of the flat muscles, thus allowing for the medialization of the rectus myofascial units utilizing elastomers and anchoring buttons (Figure 5).…”

Section: Discussionmentioning

confidence: 99%

Stoma Retraction in Super-Morbidly Obese Patient Leading to Class IV Midline Wound: A Cautionary Tale

Morgan

John

Youssi

et al. 2022

Journal of Investigative Medicine High Impact Case Reports

View full text Add to dashboard Cite

Stoma creation is often necessary for fecal diversion in general surgery. The creation of stomas involves mobilization of either the large or small intestine through the abdominal wall to allow for the passage of waste that traverses the intestinal tract. Among the complications of stoma creation, particularly in obese patients, is stoma retraction, whereby the stoma retracts greater than 5 mm from the skin. This is often accompanied by extensive dermal dehiscence, which can lead to significant leakage resulting in infection. Here, we present the case of a super-morbidly obese female patient with an end ileostomy following total colectomy in which abdominal closure was not initially achieved. The stoma became retracted and dehisced leading to continued contamination of the open abdomen, necessitating multiple abdominal washouts. Injection of 300 units of botulinum toxin A (BTA) was administered into the abdominal wall muscles later the day of her index operation. An Abdominal Wall Reapproximation Anchor (ABRA) dynamic tissue system (DTS) was utilized successfully in subsequent operations for primary myofascial closure. Heavy continuous contamination of the midline wound through the subcutaneous cleft between the retracted ileostomy and midline surgical wound was treated with intensive wound care, strict bed rest, nothing to eat or drink (NPO), and total parenteral nutrition (TPN). Post-operative stoma complications occur frequently, and stoma retraction is commonly encountered, especially in the obese. The patient presented in this case study had multiple risk factors which led to a complicated treatment course. Successful primary myofascial closure and complete healing of the midline surgical wound highlights the importance of a patient-tailored multimodal approach.

show abstract

Section: Discussionmentioning

confidence: 99%

Stoma Retraction in Super-Morbidly Obese Patient Leading to Class IV Midline Wound: A Cautionary Tale

Morgan

John

Youssi

et al. 2022

Journal of Investigative Medicine High Impact Case Reports

View full text Add to dashboard Cite

show abstract

“…Due to the nature of the pathology and surgical lesion, patients who are candidates for open abdomen may require multiple surgical interventions until adequate control and/or definitive resolution of the abdominal index event is achieved. This may be associated with significant complications, including enteroatmospheric fistulas, loss of abdominal wall domain, and large hernias of the abdominal wall 8 .…”

Section: Discussionmentioning

confidence: 99%

Terapia por pressão subatmosférica de baixo custo como alternativa para fechamento abdominal temporário em hospital público: relato de caso

Gonçalves

Lima

Cordeiro³

et al. 2021

Rev. Med. (São Paulo)

View full text Add to dashboard Cite

A utilização da pressão subatmosférica através de curativo à vácuo em pacientes com abdome aberto é usada cada vez mais para o fechamento abdominal temporário. O curativo à vácuo pode ser utilizado como uma “ponte” entre o surgimento da lesão inicial e a cirurgia de fechamento definitivo da ferida, naqueles casos em que o fechamento fascial primário não é possível. O objetivo deste trabalho é apresentar uma proposta prática para o fechamento abdominal temporário utilizando curativo à vácuo (técnica de Barker modificada), como alternativas as demais técnicas. O mecanismo de ação envolve o controle do exsudato, redução do edema intersticial perilesional, aumento do fluxo sanguíneo, estímulo à formação de tecido de granulação e contração da ferida. O curativo apresentou baixos custos, fácil aplicação e utilizando materiais disponíveis com frequência na maioria dos hospitais públicos. De acordo com a literatura, a técnica de Barker modificada apresenta bons resultados e índices de complicações semelhantes aos kits de TPN comerciais.

show abstract

“…This technique ensures appropriate evacuation of ascites rich in pro-inflammatory markers and contamination,69 improves nursing care, and prevents retraction of fascial edges, facilitating early definitive fascial closure (Figure 3). 68,70 Temporary closure in OA without negative pressure can be currently considered only if NPWT is not available (low resource setting), resulting frequently in a delayed fascial closure and increased intestinal fistula rates 67,68Figure 3A clinical image of a patient with aortic injury subjected to damage control laparotomy with temporary abdominal closure using negative pressure wound therapy (NPWT). Note: Photo courtesy of Peep Talving.…”

Section: Management Of Acsmentioning

confidence: 99%

“…Application of NPWT has significantly reduced the complication rate as well as nursing workload. Different commercial products for NPWT are available 64,70. The optimal negative pressure has been suggested to be −125 mmHg, with lower level (−70 mmHg) when active bleeding due to coagulopathy is suspected 67.…”

Section: Patient With Open Abdomen In Intensive Carementioning

confidence: 99%

<p>Abdominal Compartment Syndrome: Improving Outcomes With A Multidisciplinary Approach – A Narrative Review</p>

Padar¹,

Blaser²,

Talving³

et al. 2019

JMDH

View full text Add to dashboard Cite

Abdominal compartment syndrome (ACS) refers to a severe increase in intra-abdominal pressure associated with single or multiorgan failure. ACS with specific pathophysiological processes and detrimental outcomes may occur in a variety of clinical conditions. Patients with ACS are predominantly managed in critical care settings, however, a wide range of multidisciplinary interventions are frequently required from medical, surgical, radiological and nursing specialties. The medical management, aiming to prevent the progression of intra-abdominal hypertension to ACS, is extensively reviewed. Timing and techniques of surgical decompression techniques, as well as management of open abdomen, are outlined. In summary, the current narrative review provides data on history, definitions, epidemiology and pathophysiology of the syndrome and highlights the importance of multidisciplinary approach in the management of ACS in adults.

show abstract

Management of the open abdomen: clinical recommendations for the trauma/acute care surgeon and general surgeon

Cited by 18 publications

References 33 publications

Stoma Retraction in Super-Morbidly Obese Patient Leading to Class IV Midline Wound: A Cautionary Tale

Stoma Retraction in Super-Morbidly Obese Patient Leading to Class IV Midline Wound: A Cautionary Tale

Terapia por pressão subatmosférica de baixo custo como alternativa para fechamento abdominal temporário em hospital público: relato de caso

<p>Abdominal Compartment Syndrome: Improving Outcomes With A Multidisciplinary Approach – A Narrative Review</p>

Contact Info

Product

Resources

About