Management of the open abdomen using vacuum-assisted wound closure and mesh-mediated fascial traction

• Published in: Langenbeck's archives of surgery Vol. 400; no. 1; pp. 91 - 99
• Main Authors: Willms, A., Güsgen, C., Schaaf, S., Bieler, D., von Websky, M., Schwab, R.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-01-2015
• Subjects: Abdominal Injuries - surgery; Abdominal Surgery; Algorithms; Cardiac Surgery; Critical Illness; Fasciotomy; General Surgery; Humans; Intention to Treat Analysis; Intra-Abdominal Hypertension - surgery; Medicine; Medicine & Public Health; Negative-Pressure Wound Therapy; Original Article; Peritonitis - surgery; Surgical Mesh; Surgical Wound Dehiscence - surgery; Thoracic Surgery; Traumatic Surgery; Vascular Surgery; Abdominal trauma; Abdominal compartment syndrome; Vacuum therapy; Peritonitis; Open abdomen
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-014-1240-4

Background
The open abdomen has become an accepted treatment option of critically ill patients with severe intra-abdominal conditions. Fascial closure is a particular challenge in patients with peritonitis. This study investigates whether fascial closure rates can be increased in peritonitis patients by using an algorithm that combines vacuum-assisted wound closure and mesh-mediated fascial traction. Moreover, fascial closure rates for patients with peritonitis, trauma or abdominal compartment system (ACS) are compared.
Methods
Data were collected prospectively from all patients who underwent open abdomen management at our institution from 2006 to 2012. All patients were treated under a standardised algorithm that combines vacuum-assisted closure and mesh placement at the fascial level.
Results
During the study period, 53 patients (mean age 53 years) underwent open abdomen management for a mean duration of 15 days. Indications for leaving the abdomen open were peritonitis (51 %), trauma (26 %), and ACS or abdominal wall dehiscence (23 %). The fascial closure rate was 79 % in an intention-to-treat analysis and 89 % in a per-protocol analysis. Mortality was 13 %. No patient developed an enteroatmospheric fistula or abdominal wall dehiscence after closure. The mean duration of treatment was significantly longer in peritonitis patients (20 days) than in patients without peritonitis (10 days) (
p
 = 0.03). There were no significant differences in fascial closure rates between patients with peritonitis (87 %), trauma (85 %), and ACS or abdominal wall dehiscence (100 %) (
p
 = 0.647).
Conclusions
Regardless of the underlying pathology, high fascial closure rates can be achieved using a combination of vacuum-assisted closure and mesh-mediated fascial traction.