Temporary closure of open abdominal wounds by the modified sandwich–vacuum pack technique

Navsaria, Pradeep; Bunting, Michael W; Omoshoro-Jones, J.; Nicol, Andrew; Kahn, Delawir

doi:10.1002/bjs.4101

Cited by 119 publications

(86 citation statements)

References 8 publications

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“…18,19 Fistulas are attributed to desiccation and erosion of the bowel wall, possibly as a result of adhesions with the underlying dressing. 20 Rao et al 12 reported a 20% incidence of fistula development in their series of patients with open abdomens treated with negative pressure therapy; of these patients 66% eventually died. They recommended caution in the use of negative pressure dressings, particularly where a bowel anastomosis has been performed or enterotomies have been closed.…”

Section: Discussionmentioning

confidence: 98%

“…18 Various methods for managing laparostomies have been described. 6,19,20 Many of these are difficult to apply and somewhat cumbersome to manage. There is a requirement for a temporary closure device that is not only simple to apply, but also actively removes wound and visceral exudates, promotes tissue granulation, minimises complications, and provides mechanical containment of abdominal contents.…”

Section: Discussionmentioning

confidence: 99%

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Initial Experience of Laparostomy with Immediate Vacuum Therapy in Patients with Severe Peritonitis

Horwood

Akbar

Maw

2009

annals

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INTRODUCTION To report our initial experience of laparostomy and immediate intra-abdominal vacuum therapy in patients with severe peritonitis due to intra-abdominal catastrophes. PATIENTS AND METHODS Twenty-seven patients underwent emergency laparotomy and laparostomy formation with the application of immediate intra-abdominal TRAC-VAC ® therapy (male:female ratio, 1:1.2; median age, 73 years; range, 34-84 years). Predicted mortality was assessed using the P-POSSUM score and compared with clinically observed outcomes. RESULTS Ten patients (37%) with a mean predicted P-POSSUM mortality of 72%, died of sepsis and multi-organ failure. Seventeen patients (mean P-POSSUM 48% expected mortality) survived to discharge. One patient with pancreatitis died from small bowel obstruction 1-year post discharge, two patients developed a small bowel fistula. One patient had an allergic reaction to the VAC dressing. Our patients, treated with laparostomy and TRAC VAC therapy, had a significantly improved observed survival when compared to P-POSSUM expected survival (P = 0.004). CONCLUSIONS Laparostomy with immediate intraperitoneal VAC therapy is a robust and effective system to manage patients with intra-abdominal catastrophes. There were significantly improved outcomes compared to the mortality predicted by P-POSSUM scores. Damage control surgery with laparostomy formation and intra-abdominal VAC therapy should be considered in patients with severe peritonitis.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Initial Experience of Laparostomy with Immediate Vacuum Therapy in Patients with Severe Peritonitis

Horwood

Akbar

Maw

2009

annals

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“…The absorbable meshes have little tensile strength and can result in evisceration during patient turning with the non-absorbables being associated with a moderate rate of intestinal fistula. 196,197 The further advantages of the VAC proprietary devices over temporary mesh usage include their versatility to the contour of large defects permitting the utilization of a laterally placed stoma in conjunction 198 and potential use even in the presence of a pre-existing intestinal fistula. 199 Where possible, stomas should be avoided as the geography of the abdominal wall may change in such a way that they retract significantly or where in a delayed setting they can compromise abdominal wall reconstruction and rectus advancements.…”

Section: Surgical Decompressionmentioning

confidence: 99%

mentioning

confidence: 99%

Primary Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: Pathophysiology and Treatment

Ap¹,

Wun²,

Chiappa³

et al. 2015

Emerg Med Open J

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Abdominal Compartment Syndrome (ACS) is a potentially lethal condition caused by various events that produce intra-abdominal hypertension. The most common cause is blunt abdominal trauma. Increasing intra-abdominal pressure causes progressive hypoperfusion and ischemia of the intestines and other peritoneal and retroperitoneal structures. Pathophysiological effects include release of cytokines, production of oxygen free radicals, and decreased cellular formation of adenosine triphosphate. These processes may lead to translocation of bacteria from the gut and intestinal edema, predisposing patients to multiorgan dysfunction syndrome. The consequences of abdominal compartment syndrome are profound and affect many vital body systems. Respiratory, hemodynamic, cardiovascular, renal, and neurological abnormalities are signs of abdominal compartment syndrome. Medical management of critically ill patients with raised intra-abdominal pressure should be instigated early to prevent further organ dysfunction and to avoid progression to ACS. Many treatment options are available and are often part of routine daily management in the ICU (nasogastric, rectal tube, prokinetics, enema, sedation, body position). Some of the newer treatments are very promising options in specific patient populations with raised IAP. Nursing care involves vigilant monitoring for early detection, including serial measurements of intra-abdominal pressure.KEYWORDS: Intra-abdominal hypertension; Abdominal compartment syndrome; Damage control laparotomy; Laparostomy; Open abdomen. DEFINITIONS, INCIDENCE AND MEASUREMENT STRATEGIES IN INTRA-ABDOMINAL HY-PERTENSION (IAH) AND ABDOMINAL COMPARTMENT SYNDROME (ACS)The concept of the Abdominal Compartment Syndrome (ACS) has been rediscovered as a final common pathway of the physiologic sequelae of increased Intra-Abdominal Pressure In each case if the graph shifts to the right, higher IAP and lower APP values may not be associated with significant end-organ dysfunction creating a degree of "ACS-resistance." Shifts to the left would create "ACS-sensitivity" where lower values of IAP (higher APP values) may still be associated with organ dysfunction which might not occur normally. This results in difficulty for broader acceptance of critical IAP and APP levels for individual cases. ACS-sensitivity may potentially occur in patients where there is pre-existing partial end-organ failure, morbid obesity or following fluid hyper-resuscitation in patients with severe burns, haemorrhagic pancreatitis, massive blood loss, widespread intra-peritoneal sepsis and high-output intestinal fistulae. 6-8There is no strict definition of what represents abnormal IAP, but there is a general acceptance that measured pressures >12 mmHg when recorded 1-6 hours apart are considered to represent IAH, where Sugrue, et al. have shown that this represents up to 40% of cases admitted to a surgical Intensive Care Unit (ICU). 9 Although there are biases in the prospective assessment of a selective population admitted to an ICU who ...

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“…51 A 3-l plastic irrigation bag is sutured to the wound edges and continuous high-pressure suction applied to achieve temporary abdominal wall closure. This is the so-called laparostomy (Fig.…”

Section: Contaminated Woundsmentioning

confidence: 99%

The Management of Incisional Hernia

Kingsnorth

2006

annals

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Ann R Coll Surg Engl 2006; 88: 252-260 252Medline and Embase were searched using the search terms 'hernia' and 'incisional' alone and in combination. Publications were selected mostly in the past 5 years, but did not exclude commonly reference and highly regarded older publications. The reference list of articles was also searched, identified by the search strategy and those selected that were relevant. Selected review articles and metaanalyses were included because they provide comprehensive overviews that may be beyond the scope of this article. OverviewThe introduction of prosthetic mesh revolutionised the treatment of groin hernia but, to date, has had little impact on the treatment of incisional hernia.1 The risk factors for the development of incisional hernia include obesity, diabetes, emergency surgery, postoperative wound dehiscence, smoking and postoperative wound infection. 2,3The risks of repairing an incisional hernia which should be explained to the patient when obtaining consent include seroma formation, wound infection, injury to intraabdominal structures and recurrence. 4 Major complications which can occur in repair of large incisional hernias include mesh infection and enterocutaneous fistula which may result in prolonged morbidity and require re-operation (Fig. 1). It is now accepted that only the smallest (less than 3 cm) incisional hernias should be repaired with primary tissue approximation with sutures and this topic will not be discussed further.5 Small incisional hernias with time develop into larger incisional hernias due to the continuous presence of intra-abdominal hydrostatic pressure of 15 cm of water, diaphragmatic contractions occurring with respiration, increases in abdominal pressure occurring with coughing and straining realising pressures of over 80 cm of water and myofascial retraction of the lateral muscles. As a result, the abdominal cavity contracts and the right of domicile for the herniated visceral mass is lost. 6 Due to several previous operations, many of these patients have poor-quality abdominal wall musculature which, coupled with multiple co-morbid medical problems, present a surgical and anaesthetic challenge.Surgeons appear to have a reluctance to operate on incisional hernias perhaps because of the poor general condition of the patients but perhaps also due to lack of knowledge of how to deal with the various defects occurring as a result of incisions of the anterior abdominal wall and the operative techniques required. For instance, although it is estimated that 13% of laparotomy incisions fail in The Netherlands, only 4% of patients undergoing a laparotomy will go through additional surgery to repair an incisional hernia.7 Suture repair is likely to produce results twice as bad as mesh repair and the current techniques that surgeons are using to repair incisional hernias with prosthetic mesh continue to yield recurrence rates of greater than 20%. Many thousand laparotomy incisions are created each year and the failure rate for closure of these abdominal wou...

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Temporary closure of open abdominal wounds by the modified sandwich–vacuum pack technique

Abstract: The modified sandwich-vacuum pack technique of temporary abdominal wall closure is easy and rapid, cost effective and provides an effective means of containing abdominal wall contents.

Cited by 119 publications

References 8 publications

Initial Experience of Laparostomy with Immediate Vacuum Therapy in Patients with Severe Peritonitis

Initial Experience of Laparostomy with Immediate Vacuum Therapy in Patients with Severe Peritonitis

Primary Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: Pathophysiology and Treatment

The Management of Incisional Hernia

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