A Prospective, Controlled Evaluation of the Abdominal Reapproximation Anchor Abdominal Wall Closure System in Combination with VAC Therapy Compared with VAC Alone in the Management of an Open Abdomen

2014 ◽  
Vol 80 (6) ◽  
pp. 567-571 ◽  
Author(s):  
Kristin L. Long ◽  
David A. Hamilton ◽  
Daniel L. Davenport ◽  
Andrew C. Bernard ◽  
Paul A. Kearney ◽  
...  
Keyword(s):  
Time Use ◽  
Primary Closure ◽  
Open Abdomen ◽  
Damage Control ◽  
Fascial Closure ◽  
Control Group ◽  
Anchor System ◽  
Controlled Evaluation ◽  
Operative Costs ◽  
Abdominal Compartment

Dramatic increases in damage control and decompressive laparotomies and a significant increase in patients with open abdominal cavities have resulted in numerous techniques to facilitate fascial closure. We hypothesized addition of the abdominal reapproximation anchor system (ABRA) to the KCI Abdominal Wound Vac™ (VAC) or KCI ABThera™ would increase successful primary closure rates and reduce operative costs. Fourteen patients with open abdomens were prospectively randomized into a control group using VAC alone (control) or a study group using VAC plus ABRA (VAC-ABRA). All patients underwent regular VAC changes; patients receiving VAC-ABRA also underwent concomitant daily elastomer adjustment of the ABRA system. Primary end points included abdominal closure, number of operating room (OR) visits, and OR time use. Eight patients were included in the VAC-ABRA group and six patients in the control group. Primary closure rates between groups were not statistically different; however, the number of trips to the OR and OR time use were different. Despite higher Acute Physiology and Chronic Health Evaluation II scores, larger starting wound size, and higher rates of abdominal compartment syndrome, closure rates in the VAC-ABRA group were similar to VAC alone. Importantly, however, fewer OR trips and less OR time were required for the VAC-ABRA group.

Direct Peritoneal Resuscitation: A Novel Adjunct to Damage Control Laparotomy

2019 ◽  
Vol 39 (6) ◽  
pp. 37-45
Author(s):  
Steven Wiseman ◽  
Ellen M. Harvey ◽  
Katie Love Bower
Keyword(s):  
Open Abdomen ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Care Practice ◽  
Successful Implementation ◽  
Resuscitation Strategy ◽  
Physiological Benefits ◽  
Procedural Components ◽  
Management Priorities ◽  
Abdominal Compartment

Direct peritoneal resuscitation is a validated resuscitation strategy for patients undergoing damage control surgery for hemorrhage, sepsis, or abdominal compartment syndrome with open abdomen and planned reexploration after a period of resuscitation in the intensive care unit. Direct peritoneal resuscitation can decrease visceral edema, normalize body water ratios, accelerate primary abdominal wall closure after damage control surgery, and prevent complications associated with open abdomen. This review article describes the physiological benefits of direct peritoneal resuscitation, how this technique fits within management priorities for the patient in shock, and procedural components in the care of open abdomen surgical patients receiving direct peritoneal resuscitation. Strategies for successful implementation of a novel multidisciplinary intervention in critical care practice are explored.

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.

The Abdominal Reapproximation Anchor Device

2016 ◽  
Vol 24 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Alfin Okullo ◽  
Mehan Siriwardhane ◽  
Tony C. Y. Pang ◽  
Jane-Louise Sinclair ◽  
Vincent W. T. Lam ◽  
...  
Keyword(s):  
Best Practice ◽  
Open Abdomen ◽  
Damage Control ◽  
Case Series ◽  
Penetrating Trauma ◽  
Apache Ii ◽  
Fascial Closure ◽  
Apache Ii Score ◽  
Skin Closure ◽  
Icu Stay

Introduction. Achieving primary fascial closure after damage control laparostomy can be challenging. A number of devices are in use, with none having yet emerged as best practice. In July 2013, at Westmead Hospital, we started using the abdominal reapproximation anchor (ABRA; Canica Design, Almonte, Ontario, Canada) device. We report on our experience. Methods. A retrospective review of medical records for patients who had open abdomens managed with the ABRA device between July to December 2013 was done. Data extracted included age, sex, body mass index (BMI), reason for the open abdomen, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, number of laparostomies prior to ABRA placement, duration of placement, device complications, length of hospital and intensive care unit (ICU) stay, and outcomes. Results. Four cases of open abdomens managed using the ABRA device were identified, with 3 a consequence of intra-abdominal sepsis and 1 a consequence of penetrating trauma. Mean BMI was 33.5 kg/m2, APACHE II score was 14.5, duration with open abdomen prior to ABRA placement was 11.75 days, duration with ABRA in situ was 9 days, duration of hospital stay was 64.25 days, and ICU stay was 37.75 days. Three patients (75%) achieved fascial closure, and 1 achieved skin closure. No incidences of enterocutaneous fistulae occurred. Conclusion. The ABRA is a unique emerging alternative to aid in achieving fascial closure in patients managed with open abdomens. Our case series demonstrates that it can be used effectively in selected patients. Studies are needed to compare its efficacy with more traditional methods.

scholarly journals Current Status of the Open Abdomen Treatment for Intra-Abdominal Infection

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Yujie Yuan ◽  
Jianan Ren ◽  
Yulong He
Keyword(s):  
Open Abdomen ◽  
Damage Control ◽  
Fluid Management ◽  
Damage Control Surgery ◽  
Skin Grafting ◽  
Current Status ◽  
Fascial Closure ◽  
Surgical Interventions ◽  
Abdominal Infection ◽  
Intra Abdominal Infection

The open abdomen has become an important approach for critically ill patients who require emergent abdominal surgical interventions. This treatment, originating from the concept of damage control surgery, was first applied in severe traumatic patients. The ultimate goal is to achieve formal abdominal fascial closure by several attempts and adjuvant therapies (fluid management, nutritional support, skin grafting, etc.). Up to the present, open abdomen therapy becomes matured and is multistage-approached in the management of patients with severe trauma. However, its application in patients with intra-abdominal infection still presents great challenges due to critical complications and poor clinical outcomes. This review focuses on the specific use of the open abdomen in such populations and detailedly introduces current concerns and advanced progress about this therapy.

scholarly journals Successful management of abdominal wound dehiscence using a vacuum assisted closure system combined with mesh-mediated medial traction

2015 ◽  
Vol 97 (1) ◽  
pp. e3-e5 ◽  
Author(s):  
AC Lord ◽  
R Hompes ◽  
A Venkatasubramaniam ◽  
S Arnold
Keyword(s):  
Abdominal Wall ◽  
Primary Closure ◽  
Open Abdomen ◽  
Wound Dehiscence ◽  
Fascial Closure ◽  
Abdominal Wound ◽  
Closure System ◽  
Vacuum Assisted Closure ◽  
Successful Management ◽  
Abdominal Wound Dehiscence

Management of the open abdomen has advanced significantly in recent years with the increasing use of vacuum assisted closure (VAC) techniques leading to increased rates of fascial closure. We present the case of a patient who suffered two complete abdominal wall dehiscences after an elective laparotomy, meaning primary closure was no longer possible. She was treated successfully with a VAC system combined with continuous medial traction using a Prolene®mesh. This technique has not been described before in the management of patients following wound dehiscence.

Damage Control Laparotomy Wound Incisions Can Be Closed With Low Rates of Superficial Surgical Site Infections

2021 ◽  
pp. 000313482110545
Author(s):  
John D. Cull ◽  
Kristen A. Spoor ◽  
Katherine F. Pellizzeri ◽  
Benjamin M. Manning
Keyword(s):  
Retrospective Review ◽  
Primary Closure ◽  
Damage Control ◽  
Surgical Site Infections ◽  
Fascial Closure ◽  
Damage Control Laparotomy ◽  
Secondary Intention ◽  
Delayed Primary Closure ◽  
Laparotomy Wound

Due to high rates of surgical site infections (SSIs) in damage control laparotomies (DCLs), many surgeons leave wounds to heal by secondary intention. We hypothesize that patients after DCL can have their wounds primarily closed with wicks/Penrose drains with low rates of superficial surgical site infections. A retrospective review of a prospectively maintained DCL database was performed for all patients who underwent DCL from January 2016 to June 2018. From January 2016 to June 2018, a total of 171 patients underwent DCL. After exclusions, 107 patients were reviewed to assess for SSI. 57 patients were closed with wicks/Penrose drains, 3 were closed with delayed primary closure, and 47 patients were closed completely at time of fascial closure. There were 4 (3.7%) superficial SSIs, 13 (12.1%) organ space infections, and 14 surgical site occurrences (3 of which required opening the skin). Primary closure of incisions after DCL has low superficial SSI rates.

scholarly journals Predictive factors of mortality in open abdomen for abdominal sepsis: a retrospective cohort study on 113 patients

2021 ◽  
Author(s):  
Dario Tartaglia ◽  
Jacopo Nicolò Marin ◽  
Alice Maria Nicoli ◽  
Andrea De Palma ◽  
Martina Picchi ◽  
...  
Keyword(s):  
Predictive Factors ◽  
Open Abdomen ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Abdominal Sepsis ◽  
Apache Ii ◽  
Fascial Closure ◽  
Apache Ii Score ◽  
Co Morbidity ◽  
Fistula Rate

AbstractOver the past few years, the open abdomen (OA) as a part of Damage Control Surgery (DCS) has been introduced as a surgical strategy with the intent to reduce the mortality of patients with severe abdominal sepsis. Aims of our study were to analyze the OA effects on patients with abdominal sepsis and identify predictive factors of mortality. Patients admitted to our institution with abdominal sepsis requiring OA from 2010 to 2019 were retrospectively analyzed. Primary outcomes were mortality, morbidity and definitive fascial closure (DFC). Comparison between groups was made via univariate and multivariate analyses. On 1474 patients operated for abdominal sepsis, 113 (7.6%) underwent OA. Male gender accounted for 52.2% of cases. Mean age was 68.1 ± 14.3 years. ASA score was > 2 in 87.9%. Mean BMI, APACHE II score and Mannheim Peritonitis Index were 26.4 ± 4.9, 15.3 ± 6.3, and 22.6 ± 7.3, respectively. A negative pressure wound system technique was used in 47% of the cases. Overall, mortality was 43.4%, morbidity 76.6%, and DFC rate was 97.8%. Entero-atmospheric fistula rate was 2.2%. At multivariate analysis, APACHE II score (OR 1.18; 95% CI 1.05–1.32; p = 0.005), Frailty Clinical Scale (OR 4.66; 95% CI 3.19–6.12; p < 0.0001) and ASA grade IV (OR 7.86; 95% CI 2.18–28.27; p = 0.002) were significantly associated with mortality. OA seems to be a safe and reliable treatment for critically ill patients with severe abdominal sepsis. Nonetheless, in these patients, co-morbidity and organ failure remain the major obstacles to a better prognosis.

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.

Challenges in the Management of the Open Abdomen

ICU Director ◽  
2012 ◽  
Vol 4 (1) ◽  
pp. 33-39 ◽  
Author(s):  
David J. Worhunsky ◽  
Gregory Magee ◽  
David A. Spain
Keyword(s):  
Open Abdomen ◽  
Damage Control ◽  
Original Description ◽  
Fascial Closure ◽  
Critically Ill Patient ◽  
Temporary Abdominal Closure ◽  
Recurrence Rates ◽  
Abdominal Closure ◽  
Intra Abdominal Infection ◽  
Temporary Closure

First described more than 60 years ago, the open abdomen has now become a relatively common entity in surgical ICUs. Although the indications for an open abdomen have evolved since the original description of the damage control laparotomy, the goal remains to provide an unstable or critically ill patient time to correct their physiologic derangements. Temporary abdominal closure is thus used as a bridge to definitive repair and closure. Unfortunately, the open abdomen is associated with significant morbidity and mortality, and recent studies have suggested an overuse of the technique. Once the decision is made to proceed with an open abdomen, multiple options exist for temporary abdominal closure. The hope is to obtain definitive closure shortly thereafter in an attempt to reduce potential complications including intra-abdominal infection or enteroatmospheric fistula. Options for temporary closure range from the Bogotá bag to vacuum-assisted techniques; a combined technique of sequential fascial closure with vacuum assistance has recently been shown to result in 100% fascial approximation. In situations where fascial closure is unattainable, temporary coverage with a skin graft may be employed, followed by late abdominal closure via complex abdominal herniorrhaphy. Even using advanced methods such as component separation or a “pork sandwich” technique, the complication and recurrence rates remain high. A careful understanding of the indications, optimal management, and potential complications of the open abdomen is necessary to limit its overuse and ultimately reduce some of the challenges associated with it.

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