Vacuum‐assisted Wound Closure and Mesh‐mediated Fascial Traction—A Novel Technique for Late Closure of the Open Abdomen

Petersson, Ulf; Acosta, Stefan; Björck, Martin

doi:10.1007/s00268-007-9222-0

Cited by 194 publications

(176 citation statements)

References 18 publications

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“…The review of 18 series with overall 1395 patients managed by OA and V.A.C. revealed a mean rate of EAFs 6.1% (Table 2), (4,8,14,17,19,20,(26)(27)(28)(29)31,32,(36)(37)(38)42,45,47), which is comparable to 7.2% in our series.…”

Section: Discussionsupporting

confidence: 76%

Enteroatmospheric fistulas - the challenge of the open abdomen

Mutafchiyski

Popivanov

Kjossev

et al. 2015

SSM

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INTRODUCTION:In the past two decades, the open abdomen (OA) technique has gained wide popularity as an effective approach in the cases with severe peritonitis, abdominal compartment syndrome and critical trauma. However, it is still associated with high complication rate. Enteroatmospheric fistulas are the most devastating complication. Despite the numerous techniques described in the literature, their management remains a challenging task.

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Section: Discussionsupporting

confidence: 76%

Enteroatmospheric fistulas - the challenge of the open abdomen

Mutafchiyski

Popivanov

Kjossev

et al. 2015

SSM

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“…7 In this paper we assessed prospectively 27 patients, after continuation No matter what type of sequential mechanism for closure of OA is used, whether these are dynamic compression sutures (DCS), static compression sutures (SCS), polypropylene meshes in terms of SMAC -sandwich mesh abdominal closure, 10 or commercially made systems (ABRA system, Canica Medical Products Inc., Ontario, Canada), they showed significantly higher ratio of possible fascia closure in patients with OA. [11][12][13][14][15][16][17][18][19] In our group the most commonly used fixation were static sutures (37.5%), in 39.5% of patients no fixation was used. If considering relative numbers, more than half of the patients with ACS (26% of all patients) had no fixation.…”

Section: Frommentioning

confidence: 99%

Prospective Assessment of the Negative Pressure Wound Therapy of the Open Abdomen

Bartko

Prochotský

Sekac

et al. 2016

NPWTJ

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Abstract-Open abdomen (OA) is a surgical approach, that emerged in last 15 years, with its management being complicated, timely and financially demanding, burdened with high morbidity and mortality. In recent years, several publications proved superiority of usage of negative pressure wound therapy (NPWT) over usage of conventional temporary abdominal closure techniques in treatment of open abdomen. Different aspects of treatment of OA with NPWT remain to be assessed and stated.Authors of the paper prospectively assessed group of 48 patients with OA, managed by one surgeon with NPWT between 2006-2014, assessing mortality and morbidity in the group stratified by indication for OA, type of sequential closure of OA, presence and management of concomitant enteroatmospheric fistula (EAF), maximal values of C-reactive protein (CRP) and Procalcitonine (PCT), and initial body mass index (BMI).Mortality of the whole group was 35.41%, rate of fascial closure 45.83% and rate of the wound closure 83.33%. Incidence of the fistula was 37.5%, of these 66.67% were successfully locally managed. Incidence of fascial closure without use of sequential closure was significantly lower as opposed to use of different techniques of sequential closure. Unsuccessful local management of EAF is significant predictor of mortality. All other data were not found to be statistically significant.Identifying specific aspects of treatment of OA by NPWT, significantly improving outcomes, and adhering to these aspects in clinical practice will further ameliorate outcomes.

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“…208 Significant delays in secondary closure which may occur for a range of complex extraabdominal reasons may result in loss of abdominal domain for gut repositioning and have resulted in a variety of approaches including prosthetic mesh insertion, tissue expansion, local abdominal wall and free flap techniques and component separation methods. [209][210][211][212][213] Equally, local effects may preclude early direct approximation including ongoing haemorrhage, coagulopathy, intraperitoneal and retroperitoneal sepsis or bowel wall oedema.…”

Section: Delayed Abdominal Wall Reconstructionmentioning

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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Vacuum‐assisted Wound Closure and Mesh‐mediated Fascial Traction—A Novel Technique for Late Closure of the Open Abdomen

Abstract: Delayed primary closure in cases with severe visceral swelling and long periods of OA seems feasible with this technique.

Cited by 194 publications

References 18 publications

Enteroatmospheric fistulas - the challenge of the open abdomen

Enteroatmospheric fistulas - the challenge of the open abdomen

Prospective Assessment of the Negative Pressure Wound Therapy of the Open Abdomen

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

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