Negative pressure wound therapy management of the “open abdomen” following trauma: a prospective study and systematic review

Abstract

IntroductionThe use of Negative Pressure Wound Therapy (NPWT) for temporary abdominal closure of open abdomen (OA) wounds is widely accepted. Published outcomes vary according to the specific nature and the aetiology that resulted in an OA. The aim of this study was to evaluate the effectiveness of a new NPWT system specifically used OA resulting from abdominal trauma.MethodsA prospective study on trauma patients requiring temporary abdominal closure (TAC) with grade 1or 2 OA was carried out. All patients were treated with NPWT (RENASYS AB Smith & Nephew) to achieve TAC. The primary outcome measure was time taken to achieve fascial closure and secondary outcomes were complications and mortality.ResultsA total of 20 patients were included. Thirteen patients (65%) achieved fascial closure following a median treatment period of 3 days. Four patients (20%) died of causes unrelated to NPWT. Complications included fistula formation in one patient (5%) with spontaneous resolution during NPWT), bowel necrosis in a single patient (5%) and three cases of infection (15%). No fistulae were present at the end of NPWT.ConclusionThis new NPWT kit is safe and effective and results in a high rate of fascial closure and low complication rates in the severely injured trauma patient.

Trans–Abdominal Wall Traction as a Universal Solution to the Management of Giant Ventral Hernias

“…Drawbacks of open abdominal management include abdominal infection, fistula, and large ventral hernia caused by lateral contracture of the myofascial components. [22][23][24][25] Options such as bridging mesh do not definitely restore abdominal integrity and frequently eventrate, leaving a persistent giant ventral hernia. 26 In addition, it leaves the rectus muscles far apart and the oblique muscles contracted, thus leaving the patient dysfunctional and disabled.…”

“…However, success rates have been variable, and hernia recurrence remains a significant problem in these patients. [22][23][24][25] With the advancement of technology, trans-abdominal wall traction in conjunction with an open abdomen protocol has significantly improved abdominal wall closure rates. We previously demonstrated a 100 percent success rate in abdominal wall closure using trans-abdominal wall traction in trauma patients in the acute setting, and it does so without altering the patient's anatomy and the need for component release.…”

Negative Pressure Wound Therapy in the Prevention of Infectious Wound Complications in Perineal Wound After Abdominoperineal Resection

“…В литературе имеются упоминания о при мене-нии ЛОД при самых различных патологиях: острой травме, ранах различного генеза, термических пора-жениях, остеомиелите, некротизирующем фасциите, пролежнях, гнойных ранах и трофических язвах, ди-абетической стопе, лимфостазе, перитоните, кишеч-ных свищах, абдоминальной травме, несостоятельно-сти кишечных анастомозов и абсцессах малого таза; в челюстно-лицевой, спинальной, торакальной, со-судистой, пластической и реконструктивной хирур-гии, в педиатрии [14,[18][19][20][21][22][23]. Использование специ-альных защитных покрытий, располагаемых между органами брюшной полости и пенополиуретановой губкой, на которую подается отрицательное давление, снижает риски развития таких осложнений, как ише-мия кишечника, кишечные свищи и кровотечения [24][25][26].…”

A selective vacuum assisted mesh mediated fascial traction approach following temporary abdominal containment for trauma laparotomy is effective in achieving closure

“…7,8 The development of sophisticated vacuum assist closure devices has allowed for better wound management and for better closure rates according to a number of authors. 9,10,11,12,13 A further technique has been described which combines both negative pressure and traction and this is known as the Vacuum Assisted Mesh Mediated Fascial Traction (VAMMFT) approach. 14,15 Our institution has used a modified VAMMFT approach for the last two years.…”