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

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Abstract

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.

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Acknowledgments

The authors would like to thank Barbara Isenberg (German Office of Languages) for her help and linguistic advice.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Ruebenacher Strasse 170, 56072, Koblenz, Germany

    A. Willms, C. Güsgen, S. Schaaf & R. Schwab

  2. Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany

    A. Willms & M. von Websky

  3. Department of Orthopaedics, Trauma Surgery, Reconstructive Surgery, Hand Surgery, Plastic Surgery, and Burn Medicine, German Armed Forces Central Hospital of Koblenz, Koblenz, Germany

    D. Bieler

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  1. A. Willms
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  2. C. Güsgen
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  5. M. von Websky
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Correspondence to A. Willms.

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Willms, A., Güsgen, C., Schaaf, S. et al. Management of the open abdomen using vacuum-assisted wound closure and mesh-mediated fascial traction. Langenbecks Arch Surg 400, 91–99 (2015). https://doi.org/10.1007/s00423-014-1240-4

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  • DOI: https://doi.org/10.1007/s00423-014-1240-4

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