scholarly journals P109 MANAGEMENT OF THE OPEN ABDOMEN WITH COMBINED THERAPIES. HOW TO AVOID VENTRAL HERNIAS AND BE ABLE TO PERFORM THE REPAIR OF THE ABDOMINAL WALL IN A DEFINITIVE WAY

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Miguel Aguirre
Keyword(s):  
Abdominal Wall ◽  
Negative Pressure ◽  
Open Abdomen ◽  
Abdominal Sepsis ◽  
Fascial Closure ◽  
Negative Pressure Therapy ◽  
Pressure Therapy ◽  
Definitive Repair ◽  
Ventral Hernias ◽  
Primary Fascial Closure

Abstract Aim To demonstrate that in patients with abdominal sepsis, delayed primary fascial closure and definitive abdominal wall repair can be achieved, in the same hospitalization, using combined therapies, which reduces the percentage of ventral hernias. Material and Methods Medical records, tomography images and outpatient controls of 9 patients were reviewed, which required open abdomen management for abdominal sepsis using negative pressure therapy combined with a dynamic fascial mesh traction, from February 2020 until May 2021. Results 9 patients (2 men and 7 women), all Grade 2C open abdomen according to Björck clasification, with a median age of 43 years (25-71). The median time therapy was 29±3 days. The primary fascial closure rate was 100% (n = 9), 77.8% (n = 7) underwent a definitive repair of the abdominal wall with absorbable synthetic mesh in the same hospitalization, while 22.2% (n = 2) did not, due to being cancer patients. The mortality rate was 11.1% (n = 1) due to pneumonia and the fistula rate was 11.1% (n = 1). None developed an incisional hernia at the one-year follow-up. Conclusions The combination of negative pressure therapy with dynamic fascial mesh traction, in the management of the open abdomen, allows us to achieve a 100% delayed primary fascial closure, avoiding ventral hernia. In the same hospitalization, while the patient leaves the critical stage, we can achieve a definitive repair of the abdominal wall using absorbable synthetic meshes returning the biomechanics to the abdominal wall, improving the quality of life of these patients.

scholarly journals P110 MANAGEMENT OF THE OPEN ABDOMEN WITH COMBINED THERAPIES. HOW TO AVOID THE VENTRAL HERNIA AND BE ABLE TO PERFORM THE REPAIR OF THE ABDOMINAL WALL IN A DEFINITIVE WAY

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Miguel Aguirre
Keyword(s):  
Abdominal Wall ◽  
Ventral Hernia ◽  
Negative Pressure ◽  
Open Abdomen ◽  
Abdominal Sepsis ◽  
Fascial Closure ◽  
Negative Pressure Therapy ◽  
Pressure Therapy ◽  
Definitive Repair ◽  
Primary Fascial Closure

Abstract Aim To demonstrate that in patients with abdominal sepsis, delayed primary fascial closure and definitive abdominal wall repair can be achieved, in the same hospitalization, using combined therapies, which reduces the percentage of ventral hernias. Material and Methods Medical records, tomography images and outpatient controls of 9 patients were reviewed, which required open abdomen management for abdominal sepsis using negative pressure therapy combined with a dynamic fascial mesh traction, from February 2020 until May 2021. Results 9 patients (2 men and 7 women), all Grade 2C open abdomen according to Björck clasification, with a median age of 43 years (25-71). The median time therapy was 29±3 days. The primary fascial closure rate was 100% (n = 9), 77.8% (n = 7) underwent a definitive repair of the abdominal wall with absorbable synthetic mesh in the same hospitalization, while 22.2% (n = 2) did not, due to being cancer patients. The mortality rate was 11.1% (n = 1) due to pneumonia and the fistula rate was 11.1% (n = 1). None developed an incisional hernia at the one-year follow-up. Conclusions The combination of negative pressure therapy with dynamic fascial mesh traction, in the management of the open abdomen, allows us to achieve a 100% delayed primary fascial closure, avoiding ventral hernia. In the same hospitalization, while the patient leaves the critical stage, we can achieve a definitive repair of the abdominal wall using absorbable synthetic meshes returning the biomechanics to the abdominal wall, improving the quality of life of these patients.

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.

scholarly journals New non-invasive device to promote primary closure of the fascia and prevent loss of domain in the open abdomen: a pilot study

2020 ◽  
Vol 5 (1) ◽  
pp. e000523
Author(s):  
Joao Baptista Rezende-Neto ◽  
Bruna Gewehr Camilotti
Keyword(s):  
Abdominal Wall ◽  
Negative Pressure ◽  
Primary Closure ◽  
Fascial Closure ◽  
Control Group ◽  
Negative Pressure Therapy ◽  
Pressure Therapy ◽  
New Device ◽  
Non Invasive ◽  
Invasive Device

BackgroundPrimary closure of the fascia at the conclusion of a stage laparotomy can be a challenging task. Current techniques to medialize the fascial edges in open abdomens entail several trips to the operating room and could result in fascial damage. We conducted a pilot study to investigate a novel non-invasive device for gradual reapproximation of the abdominal wall fascia in the open abdomen.MethodsMechanically ventilated patients ≥16 years of age with the abdominal fascia deliberately left open after a midline laparotomy for trauma and acute care surgery were randomized into two groups. Control group patients underwent standard care with negative pressure therapy only. Device group patients were treated with negative pressure therapy in conjunction with the new device for fascial reapproximation. Exclusion criteria: pregnancy, traumatic hernias, pre-existing ventral hernias, burns, and body mass index ≥40 kg/m2. The primary outcome was successful fascial closure by direct suture of the fascia without mesh or component separation. Secondary outcomes were abdominal wall complications.ResultsThirty-eight patients were investigated, 20 in the device group and 18 in the control group. Primary closure of the fascia by direct suture without mesh or component separation was achieved in 17 patients (85%) in the device group and only 10 patients (55.6%) in the control group (p=0.0457). Device group patients were 53% more likely to experience primary fascial closure by direct suture than control group patients. Device group showed gradual reduction (p<0.005) in the size of the fascial defects; not seen in control group. There were no complications related to the device.ConclusionsThe new device applied externally on the abdominal wall promoted reapproximation of the fascia in the midline, preserved the integrity of the fascia, and improved primary fascial closure rate compared with negative pressure therapy system only.Level of evidenceI, randomized controlled trial.

Negative Pressure Therapy in the Surgical Treatment of Diabetic Foot

2017 ◽  
Vol 68 (7) ◽  
pp. 1648-1651
Author(s):  
Bogdan Mihnea Ciuntu ◽  
Ciprian Vasiluta ◽  
Robert Negru ◽  
Roxana Hultoana ◽  
Roxana Ciuntu ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Negative Pressure ◽  
Diabetic Foot ◽  
Bacterial Load ◽  
Abdominal Wall Defects ◽  
Negative Pressure Therapy ◽  
Simultaneous Application ◽  
Average Hospital ◽  
Pressure Therapy ◽  
Days Of Therapy

The study aims to assess the significance of negative pressure therapy in the treatment of diabetic foot.The objectives intend to evaluate the healing time required after applying the method and the functional consequences for the patient. A prospective study was conducted on a sample of 37 patients with diabetic foot were monitored their clinical course between September 2014 - April 2017, following negative pressure therapy. There were used vacuum assisted closure devices (VAC � -Hartman) in order to apply negative pressure to the wound, while complying with specified settings (negative pressure, time of use of a kit) in accordance with patients� outcome.There were monitored changes in wound size (planimetric and volumetric measurement), their bacterial load and duration of treatment. Healing was obtained in all cases, to an average hospital stay of 27.3 days and 8 days of therapy application.The negative result of microbial cultures was obtained after an average of 6.45 days by simultaneous application of negative pressure and antibiotic treatment according to the antibiogram. Skin grafts were necessary to close the defect in 4 cases. After basic treatment of the wound, auxiliary methods such as negative pressure contribute to the healing.In patients with diabetic foot who were required surgical intervention, the use of negative pressure therapy yielded a significant benefit in the preservation of the affected limb, after minimal excision.The results we obtained throughout our experience recommend use of NPTW technique as indication for abdominal wall surgery in closing abdominal wall defects, compartment syndrome and surgical site infection after prosthetic mesh.

scholarly journals Treatment of the open abdomen with topical negative pressure therapy: a retrospective study of 46 cases

2011 ◽  
Vol 8 (3) ◽  
pp. 274-279 ◽  
Author(s):  
Aleidis Caro ◽  
Carles Olona ◽  
Andrea Jiménez ◽  
Jordi Vadillo ◽  
Francesc Feliu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Negative Pressure ◽  
Open Abdomen ◽  
Negative Pressure Therapy ◽  
Pressure Therapy ◽  
Topical Negative Pressure

scholarly journals Damage control surgery for grade IV blunt hepatic injury with multiple organ damage in a child: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Jun Soma ◽  
Daisuke Ishii ◽  
Hisayuki Miyagi ◽  
Seiya Ishii ◽  
Keita Motoki ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Hepatic Injury ◽  
Open Abdomen ◽  
Damage Control ◽  
Organ Damage ◽  
Multiple Organ ◽  
Negative Pressure Therapy ◽  
Pressure Therapy ◽  
Neurological Sequelae ◽  
Blunt Hepatic Injury

Abstract Background Intra-abdominal hemorrhage caused by blunt hepatic injury is a major cause of morbidity and mortality in patients with abdominal trauma. Some of these patients require laparotomy, and rapid decision-making and life-saving surgery are essential. Damage control (DC) surgery is useful for treating children in critical situations. We performed this technique to treat an 8-year-old boy with grade IV blunt hepatic injury and multiple organ damage. This is the first report of the use of the ABTHERA Open Abdomen Negative Pressure Therapy System (KCI, now part of 3 M Company, San Antonio, TX, USA) for DC surgery to rescue a patient without neurological sequelae. Case presentation An 8-year-old boy was brought to the emergency department of our hospital after being run over by a motor vehicle. He had grade IV blunt hepatic injury, thyroid injury, and bilateral hemopneumothorax. Although he was hemodynamically stable, the patient’s altered level of consciousness, the presence of a sign of peritoneal irritation, and suspicion of intestinal injury led us to perform exploratory laparotomy. As part of a DC strategy, we performed gauze packing to control hemorrhage from the liver and covered the abdomen with an ABTHERA Open Abdomen Negative Pressure Therapy System to improve the patient’s general condition. Eighteen days after admission, the patient was diagnosed with a biliary fistula, which improved with percutaneous and external drainage. He had no neurological sequelae and was discharged 102 days after injury. Conclusion The DC strategy was effective in children with severe blunt hepatic injury. We opted to perform DC surgery because children have less hemodynamic reserve than adults, and we believe that using this strategy before the appearance of trauma triad of death could save lives and improve outcomes. During conservative management, it is important to adopt a multistage, flexible approach to achieve a good outcome.

Negative Pressure Therapy for High-Risk Abdominal Wall Reconstruction Incisions

2013 ◽  
Vol 14 (3) ◽  
pp. 270-274 ◽  
Author(s):  
Eric M. Pauli ◽  
David M. Krpata ◽  
Yuri W. Novitsky ◽  
Michael J. Rosen
Keyword(s):  
High Risk ◽  
Abdominal Wall ◽  
Negative Pressure ◽  
Abdominal Wall Reconstruction ◽  
Negative Pressure Therapy ◽  
Pressure Therapy

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.

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