Skip to main content
SpringerLink
Log in

Vacuum-Assisted Closure of Postoperative Abdominal Wounds: A Prospective Study

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

We aimed to study outcome in patients with an open abdomen in whom the abdominal vacuum-assisted closure system (V.A.C.® Therapy™) was used to provide temporary cover and achieve wound closure.

Methods

All patients in whom V.A.C. Therapy was used to manage laparotomy wounds between February 2006 and May 2007 at a University Teaching Hospital were followed up prospectively until successful completion or stoppage of V.A.C. Therapy.

Results

Of the 51 consecutive patients (33 male), V.A.C. Therapy was used to manage a laparostomy in 10 patients and abdominal wound dehiscence in 41. Median (IQR) duration of V.A.C. Therapy was 17 (7–26) days. Wound healing was achieved in 31 (61%) patients, four of whom had additional surgery to assist wound closure. The rest healed by secondary intention. Treatment was withdrawn due to therapy-related complications in nine patients and due to medical or logistical reasons in seven. Four patients died while on therapy. While most V.A.C. Therapy-related problems were minor, two patients developed enteric fistulae that necessitated surgical repair. At a median (IQR) follow-up of 8 (4–13) months, 18 patients had stable cutaneous coverage with no incisional hernia, 12 developed an incisional hernia, 9 were lost to follow-up, and 12 died.

Conclusions

V.A.C. Therapy is a useful adjunct in the management of the open abdomen and should be considered in the treatment of this problem. Restoration of cutaneous and fascial integrity of the abdominal wall, the risk of fistulisation, and the cost-effectiveness of this therapy require further evaluation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Fernandez L, Norwood S, Roettger R et al (1996) Temporary intravenous bag silo closure in severe abdominal trauma. J Trauma 40:258–260

    Article  PubMed  CAS  Google Scholar 

  2. Mayberry JC, Mullins RJ, Crass RA et al (1997) Prevention of abdominal compartment syndrome by absorbable mesh prosthesis closure. Arch Surg 132:957–961

    PubMed  CAS  Google Scholar 

  3. Nagy KK, Fildes JJ, Mahr C et al (1996) Experience with three prosthetic materials in temporary abdominal wall closure. Am Surg 62:331–335

    PubMed  CAS  Google Scholar 

  4. Akers DL Jr, Fowl RJ, Kempczinski RF et al (1991) Temporary closure of the abdominal wall by use of silicone rubber sheets after operative repair of ruptured abdominal aortic aneurysms. J Vasc Surg 14:48–52

    Article  PubMed  Google Scholar 

  5. Mizrahi S, Deutsch M, Hayes D et al (1993) Improved zipper closure of the abdominal wall in patients requiring multiple intra-abdominal operations. Am J Surg 166:62–63

    Article  PubMed  CAS  Google Scholar 

  6. Barker DE, Kaufman HJ, Smith LA et al (2000) Vacuum pack technique of temporary abdominal closure: a 7-year experience with 112 patients. J Trauma 48:201–206

    Article  PubMed  CAS  Google Scholar 

  7. Fabian TC, Croce MA, Pritchard FE et al (1994) Planned ventral hernia. Staged management for acute abdominal wall defects. Ann Surg 219:643–650; discussion 651–653

    Article  PubMed  CAS  Google Scholar 

  8. Argenta LC, Morykwas MJ (1997) Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg 38:563–576; discussion 577

    Article  PubMed  CAS  Google Scholar 

  9. Morykwas MJ, Argenta L, Shelton-Brown EI et al (1997) Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 38:553–562

    Article  PubMed  CAS  Google Scholar 

  10. Stawicki SP, Schwarz NS, Schrag SP et al (2007) Application of vacuum-assisted therapy in postoperative ascitic fluid leaks: an integral part of multimodality wound management in cirrhotic patients. J Burns Wounds 6:e7

    PubMed  Google Scholar 

  11. Cro C, George KJ, Donnelly J et al (2002) Vacuum-assisted closure system in the management of enterocutaneous fistulae. Postgrad Med J 78:364–365

    Article  PubMed  CAS  Google Scholar 

  12. Draus JM Jr, Huss SA, Harty NJ et al (2006) Enterocutaneous fistula: are treatments improving? Surgery 140:570–576; discussion 576–578

    Article  PubMed  Google Scholar 

  13. Suliburk JW, Ware DN, Balogh Z et al (2003) Vacuum-assisted wound closure achieves early fascial closure of open abdomens after severe trauma. J Trauma 55:1155–1160; discussion 1160–1161

    Article  PubMed  Google Scholar 

  14. Heller L, Levin SL, Butler CE (2006) Management of abdominal wound dehiscence using vacuum assisted closure in patients with compromised healing. Am J Surg 191:165–172

    Article  PubMed  Google Scholar 

  15. Perez D, Wildi S, Demartines N et al (2007) Prospective evaluation of vacuum-assisted closure in abdominal compartment syndrome and severe abdominal sepsis. J Am Coll Surg 205:586–592

    Article  PubMed  Google Scholar 

  16. Cipolla J, Stawicki SP, Hoff WS et al (2005) A proposed algorithm for managing the open abdomen. Am Surg 71:202–207

    PubMed  Google Scholar 

  17. Banwell PE, Téot L (2003) Topical negative pressure (TNP): the evolution of a novel wound therapy. J Wound Care 12:22–28

    PubMed  CAS  Google Scholar 

  18. Stone PA, Hass SM, Flaherty SK et al (2004) Vacuum-assisted fascial closure for patients with abdominal trauma. J Trauma 57:1082–1086

    Article  PubMed  Google Scholar 

  19. Barker DE, Green JM, Maxwell RA et al (2007) Experience with vacuum-pack temporary abdominal wound closure in 258 trauma and general and vascular surgical patients. J Am Coll Surg 204:784–792; discussion 792–793

    Article  PubMed  Google Scholar 

  20. Miller PR, Meredith JW, Johnson JC et al (2004) Prospective evaluation of vacuum-assisted fascial closure after open abdomen: planned ventral hernia rate is substantially reduced. Ann Surg 239:608–614; discussion 614–616

    Article  PubMed  Google Scholar 

  21. Petersson U, Acosta S, Björck M (2007) Vacuum-assisted wound closure and mesh-mediated fascial traction - a novel technique for late closure of the open abdomen. World J Surg 31:2133–2137

    Article  PubMed  Google Scholar 

  22. Cothren CC, Moore EE, Johnson JL et al (2006) One hundred percent fascial approximation with sequential abdominal closure of the open abdomen. Am J Surg 192:238–242

    Article  PubMed  Google Scholar 

  23. Mayberry JC, Burgess EA, Goldman RK et al (2004) Enterocutaneous fistula and ventral hernia after absorbable mesh prosthesis closure for trauma: the plain truth. J Trauma 57:157–162; discussion 163

    Article  PubMed  Google Scholar 

  24. Rao M, Burke D, Finan PJ et al (2007) The use of vacuum-assisted closure of abdominal wounds: a word of caution. Colorectal Dis 9:266–268

    Article  PubMed  CAS  Google Scholar 

  25. Fansler RF, Taheri P, Cullinane C et al (1995) Polypropylene mesh closure of the complicated abdominal wound. Am J Surg 170:15–18

    Article  PubMed  CAS  Google Scholar 

  26. Erdmann D, Drye C, Heller L et al (2001) Abdominal wall defect and enterocutaneous fistula treatment with the vacuum-assisted closure (VAC) system. Plast Reconstr Surg 108:2066–2068

    Article  PubMed  CAS  Google Scholar 

  27. Navsaria PH, Bunting M, Omoshoro-Jones J et al (2003) Temporary closure of open abdominal wounds by the modified sandwich-vacuum pack technique. Br J Surg 90:718–722

    Article  PubMed  CAS  Google Scholar 

  28. Schein M (1990) Intestinal fistulas and the open management of the septic abdomen. Arch Surg 125:1516–1517

    PubMed  CAS  Google Scholar 

  29. Mendes-Eastman S (1998) Negative pressure wound therapy. Plast Surg Nursing 18:27–37

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre Biomedical Research Unit, Nottingham University Hospitals, Queen’s Medical Centre, Nottingham, NG7 2UH, UK

    Sriram Subramonia, Brian J. Rowlands & Dileep N. Lobo

  2. Tissue Viability Service, Sherwood Health Centre, Nottingham City Primary Care Trust, Nottingham, NG5 4AD, UK

    Sarah Pankhurst

Authors
  1. Sriram Subramonia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarah Pankhurst
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brian J. Rowlands
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dileep N. Lobo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dileep N. Lobo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Subramonia, S., Pankhurst, S., Rowlands, B.J. et al. Vacuum-Assisted Closure of Postoperative Abdominal Wounds: A Prospective Study. World J Surg 33, 931–937 (2009). https://doi.org/10.1007/s00268-009-9947-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-009-9947-z

Keywords

Search

Navigation