scholarly journals DEVELOPMENT OF OPEN ABDOMEN DEVICE BASED ON BIODESIGN METHODOLOGY

2021 ◽  
Vol 1 ◽  
pp. 1253-1262
Author(s):  
Manuela Sierra ◽  
Salín Pereira ◽  
Juan Felipe Isaza ◽  
Iván Darío Montoya ◽  
Christian Andrés Diaz ◽  
...  
Keyword(s):  
Open Abdomen ◽  
Innovation Process ◽  
Physical And Mechanical Properties ◽  
Control Group ◽  
Abdominal Pressure ◽  
Temporary Abdominal Closure ◽  
New Device ◽  
Abdominal Closure ◽  
Healthcare Needs ◽  
And Control

AbstractOpen Abdomen (OA) therapy, is purposely leaving the fascial edges of the abdomen un-approximated after a laparotomy. During the OA therapy, there must be a temporary abdominal closure (TAC) device installed in the patient to achieve abdominal closure gradually without affecting its safety. However, the actual TAC devices have some gaps in terms of functionality or usability, therefore a new device is proposed. Intending to design a usable and functional technique for patients all over the world, the BioDesign Innovation Process was used. This iterative methodology focuses on healthcare needs, invention, and concept development with three main phases: Identify, Invent and Implement. At the end of these phases, the team successfully developed two new abdominal closure techniques that fill in the gaps of functionality and usability, using a simulator that realistically mimicked the physical and mechanical properties of an open abdomen. In terms of functionality, the novel techniques showed safe installation, operational security, secure grip, low invasiveness and control of intra-abdominal pressure. In terms of usability, the devices showed better results in efficiency, effectiveness and easy re-exploration than the control group.

scholarly journals Successful Use of Negative Pressure Wound Therapy for Abdominal Wall Necrosis Caused by a Perforated Ascending Colon Using the ABThera System

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Kouki Imaoka ◽  
Takuya Yano ◽  
Yasuhiro Choda ◽  
Ko Oshita ◽  
Yuma Tani ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Open Abdomen ◽  
Anterolateral Thigh Flap ◽  
Temporary Abdominal Closure ◽  
Ascending Colon ◽  
Wound Therapy ◽  
Pressure Therapy ◽  
New Device

Background. The practice of leaving the abdomen open after an emergency laparotomy has gained increasing popularity recently. Negative pressure wound therapy (NPWT) is known as an effective technique in the management of an open abdomen (OA). A new device, the ABThera™ Open Abdomen Negative Pressure Therapy System (KCI USA, San Antonio, TX, USA), was specifically designed to achieve a temporary abdominal closure (TAC) in the management of an OA. This study was aimed at presenting a successful experience of treating a case of abdominal wall necrosis caused by a perforated ascending colon using the ABThera System. Case Presentation. A 66-year-old man was admitted to our hospital with complaints of severe pain in the abdomen. On admission, abdominal contrast-enhanced computed tomography (CT) showed fluid collection, an air pocket in the subcutaneous fat layer of the abdominal wall, and edematous changes in the adipose tissue in the peritoneum and abdominal wall. Based on a diagnosis of peritonitis resulting from a perforated ascending colon, emergency surgery was performed. A right hemicolectomy, ileostomy construction, and debridement of the necrotic tissues were performed. However, necrotizing fasciitis rapidly spread; therefore, more necrotic tissue was debrided in a second operation. The abdominal wall defect was left open, and the ABThera System was used in the management of the OA; this device promoted wound healing. A reduction was observed in the size of the open wound with visible granulation tissue. The defect was finally covered with a mesh split-thickness skin graft and anterolateral thigh flap. Conclusions. In the management of a case of a massive wound with infection, it can be of great benefit to treat the wound with NPWT initially to decrease its size. The ABThera System could facilitate early and safe management of an OA by surgeons.

scholarly journals The Relationship Between Intraabdominal Hypertension and Preeclampsia

2016 ◽  
pp. 5
Author(s):  
Mesut A. Ünsal ◽  
Ülkü İnce ◽  
Sevil Cengiz ◽  
S. Caner Karahan ◽  
Turhan Aran
Keyword(s):  
Statistical Significance ◽  
Intraabdominal Pressure ◽  
Control Group ◽  
Abdominal Pressure ◽  
Study Group ◽  
Abdominal Hypertension ◽  
Intraabdominal Hypertension ◽  
The Mean ◽  
And Control ◽  
The Relationship

<p><strong>OBJECTIVE:</strong> We aimed to measure abdominal pressure and placental levels of malondialdehyde in patients with preeclampsia and investigate the relationship between intraabdominal pressure and clinical features of preeclampsia.<br /><strong>STUDY DESIGN:</strong> Study was conducted at a tertiary referral clinic. Study group consisted of patients with preeclampsia and control group consisted of normotensive pregnant women. Both placental malondialdehyde and intraabdominal pressure levels were studied in all patients. Intraabdominal pressure was assessed indirectly via a Foley bladder catheter both antepartum and postpartum period. Statistical comparisons among groups were made using the Mann-Whitney U test, independent T test and Chi-square test. Statistical significance was set as p&lt;0.05.<br /><strong>RESULTS:</strong> Study and control group consisted of 35 pregnant patients. The mean patients’ age, gravidity, parity, weight and BMI were not different between study and control groups. In the study group, Caesarean, preterm delivery and abdominal hypertension rate were significantly higher whereas the mean neonatal birth weight was lower. The mean antepartum and postpartum intraabdominal pressure levels were significantly higher in study group. The mean intraabdominal pressure was highest in patients with oliguria (19.8±1.8 cmH2O). Abdominal hypertension was detected in 30 (86%) patients in study group and in 3 (9%) patients in control group. The mean placental malondialdehyde level was significantly higher in patients with intraabdominal hypertension.<br /><strong>CONCLUSION:</strong> Abdominal hypertension rate is very high in patients with preeclampsia. Abdominal hypertension may have an additional role in preeclampsia.</p>

The open abdomen

2021 ◽  
pp. 1179-1184
Author(s):  
Omar A. Khan ◽  
Emma Rose McGlone ◽  
Marcus Reddy
Keyword(s):  
Negative Pressure ◽  
Open Abdomen ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Temporary Abdominal Closure ◽  
Systemic Complications ◽  
Advantages And Disadvantages ◽  
Abdominal Closure ◽  
Local And Systemic Complications ◽  
Abdominal Compartment

This chapter introduces the concept of the open abdomen and describes the various aetiologies of this complex condition, including the rationale for elective laparostomy in damage control surgery and as a treatment for abdominal compartment syndrome. The significance of the open abdomen is described in terms of its local and systemic complications, which form the basis of the established classification. Important considerations in the acute systemic management of patients with this condition are outlined, and methods of temporary abdominal closure are described. Advantages and disadvantages of these alternatives, including the use of negative-pressure wound therapy, are discussed.

Should Negative Pressure Therapy Replace Any Other Temporary Abdominal Closure Device in Open-Abdomen Management of Secondary Peritonitis?

2021 ◽  
Author(s):  
Vincenzo Pappalardo ◽  
Stefano Rausei ◽  
Vincenzo Ardita ◽  
Luigi Boni ◽  
Gianlorenzo Dionigi
Keyword(s):  
Negative Pressure ◽  
Open Abdomen ◽  
Secondary Peritonitis ◽  
Fascial Closure ◽  
Temporary Abdominal Closure ◽  
Negative Pressure Therapy ◽  
Pressure Therapy ◽  
Advantages And Disadvantages ◽  
Abdominal Closure ◽  
Primary Fascial Closure

AIM: To clarify the advantages of negative pressure therapy (NPT) compared to other methods of temporary abdominal closure (TAC) in the management of secondary peritonitis. METHODS: We retraced the history of known methods of TAC, and analyzed their advantages and disadvantages. We evaluated as the NPT mechanisms, both from the macroscopic that bio-molecular point of view, well suits to manage this difficult condition. RESULTS: The ideal TAC technique should be quick to apply, easy to change, protect and contain the abdominal viscera, decrease bowel edema, prevent loss of domain and abdominal compartment syndrome, limit contamination, allow egress of peritoneal fluid (and its estimation) and not result in adhesions. It should also be cost-effective, minimize the number of dressing changes and the number of surgical revisions, and ensure a high rate of early closure with a low rate of complications (especially entero-atmospheric fistula). For NPT, the reported fistula rate is 7%, primary fascial closure ranges from 33 to 100% (average 60%) and the mortality rate is about 20%. With the use of NPT as TAC, it may be possible to extend the window of time to achieve primary fascial closure (for up to 20-40 days). CONCLUSION: NPT has several potential advantages in open-abdomen (OA) management of secondary peritonitis and may make it possible to achieve all the goals suggested above for an ideal TAC system. Only trained staff should use NPT, following the manufacturer’s instructions when commercial products are used. Even if there was a significant evolution in OA management, we believe that further research into the role of NPT for secondary peritonitis is necessary.

Application of pie-crusting technique to facilitate closure of open abdomen after decompressive laparotomy

2021 ◽  
Vol 14 (8) ◽  
pp. e244219
Author(s):  
Thomas J Martin ◽  
Tareq Kheirbek
Keyword(s):  
Abdominal Wall ◽  
Primary Closure ◽  
Open Abdomen ◽  
Abdominal Wall Reconstruction ◽  
Skin Grafting ◽  
Temporary Abdominal Closure ◽  
Pressure Therapy ◽  
Abdominal Closure ◽  
Decompressive Laparotomy ◽  
Split Thickness Skin Grafting

We present the case of a 23-year-old man who developed abdominal compartment syndrome secondary to severe pancreatitis and required decompressive laparotomy and pancreatic necrosectomy. Despite application of a temporary abdominal closure system (ABThera Open Abdomen Negative Pressure Therapy), extensive retroperitoneal oedema and inflammation continued to contribute to loss of domain and prevented primary closure of the skin and fascia. The usual course of action would have involved reapplication of ABThera system until primary closure could be achieved or sufficient granulation tissue permitted split-thickness skin grafting. Though a safe option for abdominal closure, application of a skin graft would delay return to baseline functional status and require eventual graft excision with abdominal wall reconstruction for this active labourer. Thus, we achieved primary closure of the skin through the novel application of abdominal wall ‘pie-crusting’, or tension-releasing multiple skin incisions, technique.

scholarly journals The STAK tool: evaluation of a new device to treat arthrofibrosis and poor range of movement following total knee arthroplasty and major knee surgery

2020 ◽  
Vol 1 (8) ◽  
pp. 465-473
Author(s):  
Sara K. Aspinall ◽  
Patrick C. Wheeler ◽  
Steven P. Godsiff ◽  
Sue M. Hignett ◽  
Daniel T. P. Fong
Keyword(s):  
Intervention Group ◽  
Cost Effective ◽  
Knee Surgery ◽  
Home Exercise ◽  
Control Group ◽  
Range Of Movement ◽  
New Device ◽  
Cost Effective Treatment ◽  
Long Term Follow Up ◽  
And Control

Aims This study aims to evaluate a new home medical stretching device called the Self Treatment Assisted Knee (STAK) tool to treat knee arthrofibrosis. Methods 35 patients post-major knee surgery with arthrofibrosis and mean range of movement (ROM) of 68° were recruited. Both the STAK intervention and control group received standard physiotherapy for eight weeks, with the intervention group additionally using the STAK at home. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford Knee Scores (OKS) were collected at all timepoints. An acceptability and home exercise questionnaire capturing adherence was recorded after each of the interventions. Results Compared to the control group, the STAK intervention group made significant gains in mean ROM (30° versus 8°, p < 0.0005), WOMAC (19 points versus 3, p < 0.0005), and OKS (8 points versus 3, p < 0.0005). The improvements in the STAK group were maintained at long-term follow-up. No patients suffered any complications relating to the STAK, and 96% of patients found the STAK tool ‘perfectly acceptable’. Conclusion The STAK tool is effective in increasing ROM and reducing pain and stiffness. Patients find it acceptable and adherence to treatment was high. This study indicates that the STAK tool would be of benefit in clinical practice and may offer a new, cost-effective treatment for arthrofibrosis. Cite this article: Bone Joint Open 2020;1-8:465–473.

scholarly journals Open abdomen treatment with negative pressure wound therapy at department for abdominal surgery, UCC Maribor: Our experiences and results

2016 ◽  
Vol 63 (1) ◽  
pp. 121-123
Author(s):  
Bojan Krebs
Keyword(s):  
Abdominal Surgery ◽  
Negative Pressure ◽  
Open Abdomen ◽  
Abdominal Cavity ◽  
Fascial Closure ◽  
Temporary Abdominal Closure ◽  
Pressure System ◽  
Abdominal Closure ◽  
Primary Surgery ◽  
Better Than

Introduction: With the development of modern surgery we often come to situation where, after the procedure, closing of abdomen is not feasable. There are many techniques of temporary abdominal closure but best results today are achieved with negative pressure system. Despite widespread use, there is still a lot of confusion regarding the indications, the application of the technique and complications. Objective: The aim of our study was to explain the system with negative pressure and show our experience and results in the treatment of patients with it. Methods: We retrospectively analyzed the data of all patients from 2011 to 2014 which were treated with negative pressure. We were interested in following data: the date of the primary surgery, diagnosis, date and indication for use of the system with negative pressure, the number of system changes, type of final closure of the abdominal cavity and the date of discharge or death. Results: Between 2011 and 2014 we treated 52 patients, 32 men and 20 women with a system with negative pressure. The average age of the patients was 67 years (25 - 85 years). 25 patients were operated on electively and due to complications we used the system for negative pressure. In 27 patients we used negative pressure system after the primary emergency procedure. Mortality was 50 %. Conclusion: The treatment of the open abdomen with negative pressure is an essential part of modern abdominal surgery. Survival after treatment with negative pressure is better than with other techniques of temporary abdominal closure. Man must take in consideration problems with fascial closure and big postoperative hernias wich demand further operations.

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