Open Abdomen pp 215-228 | Cite as

Open Abdomen Complications: Prevention and Management

  • Antonio TarasconiEmail author
  • Osvaldo Chiara
  • Stefania Cimbanassi
  • Arianna Birindelli
  • Roberto Cirocchi
  • Gregorio Tugnoli
  • Salomone Di Saverio
Part of the Hot Topics in Acute Care Surgery and Trauma book series (HTACST)


The increasing comprehension of the patho-physiology of trauma and Abdominal Compartment Syndrome (ACS) made the Open Abdomen (OA) a cornerstone step of damage control surgery (DCS), but the exposure of the abdominal viscera to the outer environment brings itself a great burden of dreadful complications, the most feared and devastating complication is the formation of an entero-atmospheric fistula (EAF mortality rate that can nowadays still be as high as up to 40%).

Surgical techniques for management of OA have evolved tremendously in the past three decades and currently the use of Negative Pressure Wound Therapy (NPWT) is the best management option. OA complications could be artificially divided in medical and surgical, where medical complications derive from the pathophysiology of a massive open abdominal wound and surgical complications arise from surgical maneuvers performed into the open abdomen.

Prevention is the key point when the use of OA in necessary: the patient should be managed by a multidisciplinary team with a specific expertizes and this team must be aware of the OA associated morbidity. Every attempt should be made to close the abdomen as soon as reasonably possible: a primary fascial closure within the first week of OA seems to be the best way to reduce the complication rate.


  1. 1.
    Pringle JH. V. Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg. 1908;48:541–9.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Ogilvie WH. The late complications of abdominal war-wounds. Lancet. 1940;2:253–6.CrossRefGoogle Scholar
  3. 3.
    Stone HH, Strom PR, Mullins RJ. Management of the major coagulopathy with onset during laparotomy. Ann Surg. 1983;197(5):532–5.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Rotondo MF, Schwab CW, Mcgonigal MD, Phillips GR, Fruchterman TM, Kauder DR, Latenser BA, Angood PA. “Damage control”: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma Inj Infect Crit Care. 1993;35:375–82. Discussion 82–3.CrossRefGoogle Scholar
  5. 5.
    Rotondo MF, Zonies DH. The damage control sequence and underlying logic. Surg Clin North Am. 1997;77:761–77.CrossRefPubMedGoogle Scholar
  6. 6.
    Becker HP, Willms A, Schwab R. Small bowel fistulas and the open abdomen. Scand J Surg. 2007;96:263–71.CrossRefPubMedGoogle Scholar
  7. 7.
    Richter S, Dold S, Doberauer JP, Mai P, Schuld J. Negative pressure wound therapy for the treatment of the open abdomen and incidence of enteral fistulas: a retrospective bicentre analysis. Gastroenterol Res Pract. 2013;2013:1–6.CrossRefGoogle Scholar
  8. 8.
    Coccolini F, Biffl W, Catena F, Ceresoli M, Chiara O, Cimbanassi S, Fattori L, Leppäniemi A, Manfredi R, Montori G, Pesenti G, Sugrue M, Ansaloni L. The open abdomen, indications, management and definitive closure. World J Emerg Surg. 2015;10(1):32.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Schecter W, Ivatury R, Rotondo M, Hirshberg A. Open abdomen after trauma and abdominal sepsis: a strategy for management. J Am Coll Surg. 2006;203:390–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Chiara O, Cimbanassi S, Biffl W, Leppaniemi A, Henry S, Scalea TM, Catena F, Ansaloni L, Chieregato A, De Blasio E, Gambale G, Gordini G, Nardi G, Paldalino P, Gossetti F, Dionigi P, Noschese G, Tugnoli G, Ribaldi S, Sgardello S, Magnone S, Rausei S, Mariani A, Mengoli F, Di Saverio S, Castriconi M, Coccolini F, Negreanu J, Razzi S, Coniglio C, Morelli F, Buonanno M, Lippi M, Trotta L, Volpi A, Fattori L, Zago M, De Rai P, Sammartano F, Manfredi R, Cingolani E. International consensus conference on open abdomen in trauma. J Trauma Acute Care Surg. 2016;80:173–83.CrossRefPubMedGoogle Scholar
  11. 11.
    Huang Q, Li J, Lau WY. Techniques for abdominal wall closure after damage control laparotomy: from temporary abdominal closure to early/delayed fascial closure-a review. Gastroenterol Res Pract. 2016;2016:2073260.PubMedGoogle Scholar
  12. 12.
    Quyn AJ, Johnston C, Hall D, Chambers A, Arapova N, Ogston S, Amin AI. The open abdomen and temporary abdominal closure systems - historical evolution and systematic review. Colorectal Dis. 2012;14:E429–38.CrossRefPubMedGoogle Scholar
  13. 13.
    Bruhin A, Ferreira F, Chariker M, Smith J, Runkel N. Systematic review and evidence based recommendations for the use of negative pressure wound therapy in the open abdomen. Int J Surg. 2014;12:1105–14.CrossRefPubMedGoogle Scholar
  14. 14.
    Rasilainen SK, Mentula PJ, Leppaniemi AK. Vacuum and mesh-mediated fascial traction for primary closure of the open abdomen in critically ill surgical patients. Br J Surg. 2012;99:1725–32.CrossRefPubMedGoogle Scholar
  15. 15.
    Fortelny RH, Hofmann A, Gruber-Blum S, Petter-Puchner AH, Glaser KS. Delayed closure of open abdomen in septic patients is facilitated by combined negative pressure wound therapy and dynamic fascial suture. Surg Endosc. 2014;28:735–40.CrossRefPubMedGoogle Scholar
  16. 16.
    Willms A, Gusgen C, Schaaf S, Bieler D, Von Websky M, Schwab R. Management of the open abdomen using vacuum-assisted wound closure and mesh-mediated fascial traction. Langenbeck’s Arch Surg. 2015;400:91–9.CrossRefGoogle Scholar
  17. 17.
    Smith PC, Tweddell JS, Bessey PQ. Alternative approaches to abdominal wound closure in severely injured patients with massive visceral edema. J Trauma Inj Infect Crit Care. 1992;32:16–20.CrossRefGoogle Scholar
  18. 18.
    Fernandez L, Norwood S, Roettger R, Wilkins HE. Temporary intravenous bag silo closure in severe abdominal trauma. J Trauma Inj Infect Crit Care. 1996;40:258–60.CrossRefGoogle Scholar
  19. 19.
    Friese RS. The open abdomen: definitions, management principles, and nutrition support considerations. Nutr Clin Pract. 2012;27:492–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Chapman R, Foran R, Dunphy JE. Management of intestinal fistulas. AJS. 1964;108:157–64.CrossRefGoogle Scholar
  21. 21.
    Schecter WP. Management of enterocutaneous fistulas. Surg Clin North Am. 2011;91:481–91.CrossRefPubMedGoogle Scholar
  22. 22.
    Davis KG, Johnson EK. Controversies in the care of the enterocutaneous fistula. Surg Clin North Am. 2013;93:231–50.CrossRefPubMedGoogle Scholar
  23. 23.
    Evenson A, Fischer J. Current management of enterocutaneous fistula. J Gastrointest Surg. 2006;10:455–64.CrossRefPubMedGoogle Scholar
  24. 24.
    Moore FA, Feliciano DV, Andrassy RJ, Mcardle AH, Booth FV, Morgenstein-Wagner TB, Kellum JM, Welling RE, Moore EE. Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Ann Surg. 1992;216(2):172–83.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Kudsk KA, Croce MA, Fabian TC, Minard G, Tolley EA, Poret HA, Kuhl MR, Brown RO. Enteral versus parenteral feeding effects on septic morbidity after blunt and penetrating abdominal trauma. Ann Surg. 1992;215(5):503–13. 11- Discussion 11-3.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Byrnes MC, Reicks P, Irwin E. Early enteral nutrition can be successfully implemented in trauma patients with an “open abdomen”. Am J Surg. 2010;199:359–62. Discussion 63.CrossRefPubMedGoogle Scholar
  27. 27.
    Yuan Y, Ren J, Gu G, Chen J, Li J. Early enteral nutrition improves outcomes of open abdomen in gastrointestinal fistula patients complicated with severe sepsis. Nutr Clin Pract. 2011;26(6):688–94.CrossRefPubMedGoogle Scholar
  28. 28.
    Dissanaike S, Pham T, Shalhub S, Warner K, Hennessy L, Moore EE, Maier RV, O’keefe GE, Cuschieri J. Effect of immediate enteral feeding on trauma patients with an open abdomen: protection from nosocomial infections. J Am Coll Surg. 2008;207:690–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Tsuei BJ, Magnuson B, Swintosky M, Flynn J, Boulanger BR, Ochoa JB, Kearney PA. Enteral nutrition in patients with an open peritoneal cavity. Nutr Clin Pract. 2003;18(3):253–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Majercik S, Kinikini M, White T. Enteroatmospheric fistula: from soup to nuts. Nutr Clin Pract. 2012;27(4):507–12.CrossRefPubMedGoogle Scholar
  31. 31.
    Yin J, Wang J, Yao D, Zhang S, Mao Q, Kong W, Ren L, Li Y, Li J. Is it feasible to implement enteral nutrition in patients with enteroatmospheric fistulae? A single-center experience. Nutr Clin Pract. 2014;29:656–61.CrossRefPubMedGoogle Scholar
  32. 32.
    Polk TM, Schwab CW. Metabolic and nutritional support of the enterocutaneous fistula patient: a three-phase approach. World J Surg. 2012;36:524–33.CrossRefPubMedGoogle Scholar
  33. 33.
    Cheatham ML, Safcsak K, Brzezinski SJ, Lube MW. Nitrogen balance, protein loss, and the open abdomen. Crit Care Med. 2007;35:127–31.CrossRefPubMedGoogle Scholar
  34. 34.
    Willcutts K, Mercer D, Ziegler J. Fistuloclysis: an interprofessional approach to nourishing the fistula patient. J Wound Ostomy Continence Nurs. 2015;42:549–53.CrossRefPubMedGoogle Scholar
  35. 35.
    Weissenfluh GM, Brundage SI, Spain DA. Early enteral nutrition after abdominal trauma: effects on septic morbidity and practicality. Nutr Clin Pract. 2006;21(5):479–84.CrossRefPubMedGoogle Scholar
  36. 36.
    Roberts DJ, Jenne CN, Ball CG, Tiruta C, Léger C, Xiao Z, Faris PD, Mcbeth PB, Doig CJ, Skinner CR, Ruddell SG, Kubes P, Kirkpatrick AW. Efficacy and safety of active negative pressure peritoneal therapy for reducing the systemic inflammatory response after damage control laparotomy (the intra-peritoneal vacuum trial): study protocol for a randomized controlled trial. Trials. 2013;14(1):141.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Panel OAA, Campbell A, Chang M, Fabian T, Franz M, Kaplan M, Moore F, Reed RL, Scott B, Silverman R. Management of the open abdomen: from initial operation to definitive closure. Am Surg. 2009;75:S1–22.Google Scholar
  38. 38.
    Bruhin A, Ferreira F, Chariker M, Smith J, Runkel N. Systematic review and evidence based recommendations for the use of negative pressure wound therapy in the open abdomen. Int J Surg. 2014:1–46.Google Scholar
  39. 39.
    Atema JJ, Gans SL, Boermeester MA. Systematic review and meta-analysis of the open abdomen and temporary abdominal closure techniques in non-trauma patients. World J Surg. 2014;39:912–25.CrossRefGoogle Scholar
  40. 40.
    Kirshtein B, Mizrahi S. Vacuum-assisted management of enteroatmospheric fistula within the open abdomen. Am Surg. 2014;80:209–10.PubMedGoogle Scholar
  41. 41.
    Miller RS, Morris JA, Diaz JJ, Herring MB, May AK. Complications after 344 damage-control open celiotomies. J Trauma Inj Infect Crit Care. 2005;59:1365–71. Discussion 71-4.CrossRefGoogle Scholar
  42. 42.
    Mintziras I, Miligkos M, Bartsch DK. High risk of fistula formation in vacuum-assisted closure therapy in patients with open abdomen due to secondary peritonitis-a retrospective analysis. Langenbeck’s Arch Surg. 2016;401:619–25.CrossRefGoogle Scholar
  43. 43.
    Schmelzle M, Alldinger I, Matthaei H, Aydin F, Wallert I, Eisenberger CF, Schulte Am Esch J 2nd, Dizdar L, Topp SA, Yang Q, Knoefel WT. Long-term vacuum-assisted closure in open abdomen due to secondary peritonitis: a retrospective evaluation of a selected group of patients. Dig Surg. 2010;27:272–8.CrossRefPubMedGoogle Scholar
  44. 44.
    Bradley MJ, Dubose JJ, Scalea TM, Holcomb JB, Shrestha B, Okoye O, Inaba K, Bee TK, Fabian TC, Whelan JF, Ivatury RR, Group Aoas. Independent predictors of enteric fistula and abdominal sepsis after damage control laparotomy: results from the prospective aast open abdomen registry. JAMA Surg. 2013;148:947–54.CrossRefPubMedGoogle Scholar
  45. 45.
    Cirocchi R, Birindelli A, Biffl WL, Mutafchiyski V, Popivanov G, Chiara O, Tugnoli G, Di Saverio S. What is the effectiveness of the negative pressure wound therapy (Npwt) in patients treated with open abdomen technique? A systematic review and meta-analysis. J Trauma Acute Care Surg. 2016;81:575–84.CrossRefPubMedGoogle Scholar
  46. 46.
    Kaushal M, Carlson GL. Management of enterocutaneous fistulas. Clin Colon Rectal Surg. 2004:79–88.Google Scholar
  47. 47.
    Lloyd DA, Gabe SM, Windsor AC. Nutrition and management of enterocutaneous fistula. Br J Surg. 2006;93:1045–55.CrossRefPubMedGoogle Scholar
  48. 48.
    Stevens P, Foulkes RE, Hartford-Beynon JS, Delicata RJ. Systematic review and meta-analysis of the role of somatostatin and its analogues in the treatment of enterocutaneous fistula. Eur J Gastroenterol Hepatol. 2011;23(10):912–22.CrossRefPubMedGoogle Scholar
  49. 49.
    Ren J, Yuan Y, Zhao Y, Gu G, Wang G, Chen J, Fan C, Wang X, Li J. Open abdomen treatment for septic patients with gastrointestinal fistula: from fistula control to definitive closure. Am Surg. 2014;80(4):339–47.PubMedGoogle Scholar
  50. 50.
    Navsaria P, Nicol A, Hudson D, Cockwill J, Smith J. Negative pressure wound therapy management of the “open abdomen” following trauma: a prospective study and systematic review. World J Emerg Surg. 2013;8:4.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Navsaria PH, Bunting M, Omoshoro-Jones J, Nicol AJ, Kahn D. Temporary closure of open abdominal wounds by the modified sandwich-vacuum pack technique. Br J Surg. 2003;90:718–22.CrossRefPubMedGoogle Scholar
  52. 52.
    Girard S, Sideman M, Spain DA. A novel approach to the problem of intestinal fistulization arising in patients managed with open peritoneal cavities. AJS. 2002;184:166–7.CrossRefGoogle Scholar
  53. 53.
    Jamshidi R, Schecter WP. Biological dressings for the management of enteric fistulas in the open abdomen: a preliminary report. Arch Surg. 2007;142:793–6.CrossRefPubMedGoogle Scholar
  54. 54.
    Bhat YM, Banerjee S, Barth BA, Chauhan SS, Gottlieb KT, Konda V, Maple JT, Murad FM, Pfau PR, Pleskow DK, Siddiqui UD, Tokar JL, Wang A, Rodriguez SA, ASGE Technology Committee. Tissue adhesives: cyanoacrylate glue and fibrin sealant. Gastrointest Endosc. 2013;78:209–15.CrossRefPubMedGoogle Scholar
  55. 55.
    Subramaniam MH, Liscum KR, Hirshberg A. The floating stoma: a new technique for controlling exposed fistulae in abdominal trauma. J Trauma Inj Infect Crit Care. 2002;53:386–8.CrossRefGoogle Scholar
  56. 56.
    Goverman J, Yelon JA, Platz JJ, Singson RC, Turcinovic M. The “Fistula Vac” a technique for management of enterocutaneous fistulae arising within the open abdomen: report of 5 cases. J Trauma Inj Infect Crit Care. 2006;60:428–31.CrossRefGoogle Scholar
  57. 57.
    D’hondt M, Devriendt D, Van Rooy F, Vansteenkiste F, D’hoore A, Penninckx F, Miserez M. Treatment of small-bowel fistulae in the open abdomen with topical negative-pressure therapy. AJS. 2011;202:E20–E4.CrossRefGoogle Scholar
  58. 58.
    Piazza R, Armstrong S, Vanderkolk W, Eriksson E, Ringler S. A modified “Fistula-Vac” technique: management of multiple enterocutaneous fistulas in the open abdomen. Plast Reconstr Surg. 2009;124:453e–5e.CrossRefPubMedGoogle Scholar
  59. 59.
    Pang TC, Morton J, Pincott S. Novel technique for isolating and dressing enteroatmospheric fistulae. ANZ J Surg. 2012;82:747–9.CrossRefPubMedGoogle Scholar
  60. 60.
    Timmons J, Russell F. The use of negative-pressure wound therapy to manage enteroatmospheric fistulae in two patients with large abdominal wounds. Int Wound J. 2013:723–9.CrossRefPubMedGoogle Scholar
  61. 61.
    Al-Khoury G, Kaufman D, Hirshberg A. Improved control of exposed fistula in the open abdomen. J Am Coll Surg. 2008;206:397–8.CrossRefPubMedGoogle Scholar
  62. 62.
    Pepe G, Magalini S, Callari C, Persiani R, Lodoli C, Gui D. Vacuum assisted closure (Vac) therapy(Tm) as a swiss knife multi-tool for enteric fistula closure: tips and tricks: a pilot study. Eur Rev Med Pharmacol Sci. 2014;18(17):2527–32.PubMedGoogle Scholar
  63. 63.
    Verhaalen A, Watkins B, Brasel K. Techniques and cost effectiveness of enteroatmospheric fistula isolation. Wounds. 2010;22(8):212–7.PubMedGoogle Scholar
  64. 64.
    Ramsay PT, Mejia VA. Management of enteroatmospheric fistulae in the open abdomen. Am Surg. 2010;76(6):637–9.PubMedGoogle Scholar
  65. 65.
    Layton B, Dubose J, Nichols S, Connaughton J, Jones T, Pratt J. Pacifying the open abdomen with concomitant intestinal fistula: a novel approach. Am J Surg. 2010;199:E48–50.CrossRefPubMedGoogle Scholar
  66. 66.
    Di Saverio S, Villani S, Biscardi A, Giorgini E, Tugnoli G. Open abdomen with concomitant enteroatmospheric fistula: validation, refinements, and adjuncts to a novel approach. J Trauma Inj Infect Crit Care. 2011;71:760–2.CrossRefGoogle Scholar
  67. 67.
    Rekstad LC, Wasmuth HH, Ystgaard B, Stornes T, Seternes A. Topical negative-pressure therapy for small bowel leakage in a frozen abdomen. J Trauma Acute Care Surg. 2013;75:487–91.CrossRefPubMedGoogle Scholar
  68. 68.
    Heineman JT, Garcia LJ, Obst MA, Chong HS, Langin JG, Humpal R, Pezzella PA, Dries DJ. Collapsible enteroatmospheric fistula isolation device: a novel, simple solution to a complex problem. J Am Coll Surg. 2015:1–8.Google Scholar
  69. 69.
    Wang G, Ren J, Liu S, Wu X, Gu G, Li J. “Fistula Patch”: making the treatment of enteroatmospheric fistulae in the open abdomen easier. J Trauma Acute Care Surg. 2013;74:1175–7.CrossRefPubMedGoogle Scholar
  70. 70.
    Ozer MT, Sinan H, Zeybek N, Peker Y. A simple novel technique for enteroatmospheric fistulae: silicone fistula plug. Int Wound J. 2014;11(Suppl 1):22–4.CrossRefPubMedGoogle Scholar
  71. 71.
    Sriussadaporn S, Sriussadaporn S, Kritayakirana K, Pak-Art R. Operative management of small bowel fistulae associated with open abdomen. Asian J Surg. 2006;29:1–7.CrossRefPubMedGoogle Scholar
  72. 72.
    Wind J, Van Koperen PJ, Slors JFM, Bemelman WA. Single-stage closure of enterocutaneous fistula and stomas in the presence of large abdominal wall defects using the components separation technique. AJS. 2009;197:24–9.CrossRefGoogle Scholar
  73. 73.
    Stephensen B, Brown J, Lambrianides A. A novel method for managing enterocutaneous fistulae in the open abdomen using a pedicle flap. J Surg Case Rep. 2012;2012:5.CrossRefPubMedPubMedCentralGoogle Scholar
  74. 74.
    Al-Nahawi MA. Rare approach to entero-atmospheric fistula. Am J Case Rep. 2013:476–80.CrossRefPubMedGoogle Scholar
  75. 75.
    Gupta R, Singh H, Talukder S, Verma GR. A new technique of closing a gastroatmospheric fistula with a rectus abdominis muscle flap. BMJ Case Rep. 2015:Bcr2015209309-Bcr.Google Scholar
  76. 76.
    Lambe G, Russell C, West C, Kalaiselvan R, Slade DAJ, Anderson ID, Watson JS, Carlson GL. Autologous reconstruction of massive enteroatmospheric fistulation with a pedicled subtotal lateral thigh flap. Br J Surg. 2012;99(7):964–72.CrossRefPubMedGoogle Scholar
  77. 77.
    Clark CE, Walker T, Bacon L, Mccoy J, Babaloa O. Staged suspension of an enteroatmospheric fistula: a novel surgical approach. Am Surg. 2013;79:E139–40.PubMedGoogle Scholar
  78. 78.
    Di Saverio S, Tarasconi A, Inaba K, Navsaria P, Coccolini F, Costa Navarro D, Mandrioli M, Vassiliu P, Jovine E, Catena F, Tugnoli G. Open abdomen with concomitant enteroatmospheric fistula: attempt to rationalize the approach to a surgical nightmare and proposal of a clinical algorithm. J Am Coll Surg. 2015;220:E23–33.CrossRefPubMedGoogle Scholar
  79. 79.
    Di Saverio S, Tarasconi A, Walczak DA, Cirocchi R, Mandrioli M, Birindelli A, Tugnoli G. Classification, prevention and management of entero-atmospheric fistula: a state-of-the-art review. Langenbeck’s Arch Surg. 2016:1–15.Google Scholar
  80. 80.
    Kirkpatrick AW, Roberts DJ, De Waele JD, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39:1190–206.CrossRefPubMedPubMedCentralGoogle Scholar
  81. 81.
    Rycerz AM, Slack P, Mcnulty AK. Distribution assessment comparing continuous and periodic wound instillation in conjunction with negative pressure wound therapy using an agar-based model. Int Wound J. 2013;10:214–20.CrossRefPubMedGoogle Scholar
  82. 82.
    Chen Y, Ye J, Song W, Chen J, Yuan Y, Ren J. Comparison of outcomes between early fascial closure and delayed abdominal closure in patients with open abdomen: a systematic review and meta-analysis. Gastroenterol Res Pract. 2014;2014:784056.PubMedPubMedCentralGoogle Scholar
  83. 83.
    Diaz JJ Jr, Dutton WD, Ott MM, Cullinane DC, Alouidor R, Armen SB, Bilanuik JW, Collier BR, Gunter OL, Jawa R, Jerome R, Kerwin AJ, Kirby JP, Lambert AL, Riordan WP, Wohltmann CD. Eastern association for the surgery of trauma: a review of the management of the open abdomen—part 2 “management of the open abdomen”. J Trauma Inj Infect Crit Care. 2011;71:502–12.CrossRefGoogle Scholar
  84. 84.
    Lindstedt S, Malmsjö M, Hlebowicz J, Ingemansson R. Comparative study of the microvascular blood flow in the intestinal wall, wound contraction and fluid evacuation during negative pressure wound therapy in laparostomy using the V.A.C. abdominal dressing and the abthera open abdomen negative pressure therapy system. Int Wound J. 2015:83–8.CrossRefPubMedGoogle Scholar
  85. 85.
    Hlebowicz J, Hansson J, Lindstedt S. Microvascular blood flow response in the intestinal wall and the omentum during negative wound pressure therapy of the open abdomen. Int J Color Dis. 2012;27:397–403.CrossRefGoogle Scholar
  86. 86.
    Carlson GL, Patrick H, Amin AI, Mcpherson G, Maclennan G, Afolabi E, Mowatt G, Campbell B. Management of the open abdomen: a national study of clinical outcome and safety of negative pressure wound therapy. Ann Surg. 2013;257:1154–9.CrossRefPubMedGoogle Scholar
  87. 87.
    Zosa BM, Como JJ, Kelly KB, He JC, Claridge JA. Planned ventral hernia following damage control laparotomy in trauma: an added year of recovery but equal long-term outcome. Hernia. 2016;20:231–8.CrossRefPubMedGoogle Scholar
  88. 88.
    Marinis A, Gkiokas G, Argyra E, Fragulidis G, Polymeneas G, Voros D. “Enteroatmospheric fistulae” - gastrointestinal openings in the open abdomen: a review and recent proposal of a surgical technique. Scand J Surg. 2013;102:61–8.CrossRefPubMedGoogle Scholar
  89. 89.
    Krpata DM, Stein SL, Eston M, Ermlich B, Blatnik JA, Novitsky YW, Rosen MJ. Outcomes of simultaneous large complex abdominal wall reconstruction and enterocutaneous fistula takedown. AJS. 2013;205:354–9.CrossRefGoogle Scholar
  90. 90.
    Dionigi G, Dionigi R, Rovera F, Boni L, Padalino P, Minoja G, Cuffari S, Carrafiello G. Treatment of high output entero-cutaneous fistulae associated with large abdominal wall defects: single center experience. Int J Surg. 2008;6:51–6.CrossRefPubMedGoogle Scholar
  91. 91.
    Demetriades D. A technique of surgical closure of complex intestinal fistulae in the open abdomen. J Trauma Inj Infect Crit Care. 2003;55:999–1001.CrossRefGoogle Scholar
  92. 92.
    Latifi R, Joseph B, Kulvatunyou N, Wynne JL, O’keeffe T, Tang A, Friese R, Rhee PM. Enterocutaneous fistulas and a hostile abdomen: reoperative surgical approaches. World J Surg. 2011:516–23.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Antonio Tarasconi
    • 1
    Email author
  • Osvaldo Chiara
    • 2
  • Stefania Cimbanassi
    • 2
  • Arianna Birindelli
    • 3
  • Roberto Cirocchi
    • 3
  • Gregorio Tugnoli
    • 3
  • Salomone Di Saverio
    • 4
  1. 1.Emergency Surgery DepartmentMaggiore Hospital of Parma, University of ParmaParmaItaly
  2. 2.Niguarda Hospital Trauma CenterMilanItaly
  3. 3.Emergency Surgery and Trauma Surgery UnitMaggiore Hospital Regional Emergency Surgery and Trauma Center – Bologna Local Health District, AUSLBolognaItaly
  4. 4.Cambridge Colorectal UnitCambridge University Hospitals NHS Foundation Trust, Addenbrooke’s HospitalCambridgeUK

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