Vacuum assisted closure with mesh mediated fascial traction of open abdominal wounds and acute fascial dehiscence, a single institution experience

• Published in: ANZ journal of surgery Vol. 93; no. 7-8; pp. 1793 - 1798
• Main Authors: Taylor, Danielle, Dooreemeah, Dilshad, Al‐Habbal, Yahya, Jacobs, Rodney
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01-07-2023; Blackwell Publishing Ltd
• Subjects: Abdomen; Botulinum toxin; Botulinum toxin type A; burst abdomen; Complications; Dehiscence; Disasters; hernia surgery; open abdomen; Toxins; Vacuum; Wounds; open abdomen; burst abdomen; hernia surgery
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.18592

Backgrounds
Laparostomy is a common means of managing surgical catastrophes, but often results in large ventral hernias which prove difficult to repair. It is also associated with high rates of enteric fistula formation. Dynamic methods of managing the open abdomen have been shown to result in higher rates of fascial closure and fewer complications. Recent publications have suggested the addition of chemical components relaxation with botulinum toxin has an added advantage over prior methods.
Methods
We report on a series of emergent cases managed by the combination of Botulinum toxin A (BTA) mediated chemical relaxation with a modified method of mesh‐mediated fascial traction (MMFT) and negative pressure wound therapy (NPWT).
Results
Thirteen cases (nine laparostomies and four fascial dehiscence) were successfully closed in a median of 12 days, using a median of 4 ‘tightenings’, with no clinical herniation detected at follow up so far (median 183 days, IQR 123–292). There were no procedure‐related complications, but one death from the underling pathology.
Conclusions
We report further cases of vacuum assisted mesh‐mediated fascial traction (VA‐MMFT) utilizing BTA in successfully managing laparostomy and abdominal wound dehiscence and continues the known high rate of successful fascial closure seen when applied in treating the open abdomen.
This is a review of a modification of a technique to close the abdominal wall after an open abdomen or acute fascial dehiscence where the fascia cannot be opposed primarily due to loss of domain.