Abdominal Wall Reconstruction After Temporary Abdominal Closure: A Ten-Year Review

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.

Download Full-text

Temporary abdominal closure followed by definitive abdominal wall reconstruction of the open abdomen

The American Journal of Surgery ◽

10.1016/j.amjsurg.2004.03.007 ◽

2004 ◽

Vol 188 (3) ◽

pp. 301-306 ◽

Cited By ~ 99

Author(s):

Thomas R. Howdieshell ◽

Charles D. Proctor ◽

Erez Sternberg ◽

Jorge I. Cué ◽

J.Sheppard Mondy ◽

...

Keyword(s):

Abdominal Wall ◽

Open Abdomen ◽

Abdominal Wall Reconstruction ◽

Temporary Abdominal Closure ◽

Abdominal Closure

Download Full-text

Management of the Open Abdomen

Seminars in Plastic Surgery ◽

10.1055/s-0038-1666802 ◽

2018 ◽

Vol 32 (03) ◽

pp. 127-132

Author(s):

Alexander Mericli

Keyword(s):

Abdominal Wall ◽

Multidisciplinary Approach ◽

Open Abdomen ◽

Abdominal Wall Reconstruction ◽

Plastic Surgeon ◽

Temporary Abdominal Closure ◽

Clinical Scenario ◽

Surgical Team ◽

Abdominal Closure ◽

The Creation

AbstractManagement of the abdominal catastrophe requires a multidisciplinary approach. The plastic surgeon is a key member of the surgical team assisting in the creation of a durable, functional anatomic abdominal wall reconstruction. Plastic surgeons must be familiar with the concepts and pathophysiology related to the open abdomen, techniques for temporary abdominal closure, and when such techniques are appropriate to implement. In this article, the authors provide a review of the open abdomen concept, which practicing plastic surgeons and trainees may find helpful if faced with this clinical scenario.

Download Full-text

Selective Germline Genome Edited Pig Meninges Grafts for the Abdominal Wall Closure in Damage Control Surgery

10.1101/2020.02.12.946178 ◽

2020 ◽

Author(s):

Lijin Zou ◽

Youlai Zhang ◽

Ying He ◽

Hui Yu ◽

Jun Chen ◽

...

Keyword(s):

Inflammatory Response ◽

Abdominal Wall ◽

Damage Control ◽

Abdominal Wall Reconstruction ◽

Rabbit Model ◽

Damage Control Surgery ◽

Electrolyte Balance ◽

Abdominal Wall Defects ◽

Temporary Abdominal Closure

AbstractReconstruction of abdominal wall defects is still a big challenge in surgery, especially where there is insufficient fascia muscular or excessive tension of the defects in emergency and life-threatening scenarios. Indeed, the concept of damage control surgery has been advanced in the management of both traumatic and nontraumatic surgical settings. The strategy requires abridged surgery and quick back to intensive care units (ICU) for aggressive resuscitation. In the damage control laparotomy, patients are left with open abdomen or provisional closure of the abdomen with a planned return to the operating room for definitive surgery. So far, various techniques have been utilized to achieve early temporary abdominal closure, but there is no clear consensus on the ideal method or material for abdominal wall reconstruction. We recently successfully created the selective germline genome-edited pig (SGGEP) and here we aimed to explore the feasibility of in vivo reconstruction of the abdominal wall in a rabbit model with SGGEP meninges grafts (SGGEP-MGs). Our result showed that the SGGEP-MGs could restore the integrity of the defect very well. After 7 weeks of engraftment, there was no sign of herniation observed, the grafts were re-vascularized, and the defects were well repaired. Histologically, the boundary between the graft and the host was very well integrated and there was no strong inflammatory response. Therefore, this kind of closure could help restore the fluid and electrolyte balance and to dampen systemic inflammatory response in damge control surgery while ADM graft failed to establish re-vascularization as the same as the SGGEP-MG. It is concluded that the meninges of SGGEP could serve as a high-quality alternative for restoring the integrity of the abdominal wall, especially for damage control surgery.

Download Full-text

Early Fascial Closure of the Damage Control Abdomen in Children

The American Surgeon ◽

10.1177/000313481007600517 ◽

2010 ◽

Vol 76 (5) ◽

pp. 497-501 ◽

Cited By ~ 2

Author(s):

Myrick C. Shinall ◽

Kaushik Mukherjee ◽

Harold N. Lovvorn

Keyword(s):

Abdominal Wall ◽

Ventral Hernia ◽

Damage Control ◽

Necrotizing Pancreatitis ◽

Abdominal Wall Reconstruction ◽

Acellular Dermal Matrix ◽

Fascial Closure ◽

Time Range ◽

Dermal Matrix ◽

Abdominal Closure

Traditional staged closure of the damage control abdomen frequently results in a ventral hernia, need for delayed abdominal wall reconstruction, and risk of multiple complications. We examined the potential benefits in children of early fascial closure of the damage control abdomen using human acellular dermal matrix (HADM). We reviewed our experience with five consecutive children sustaining intra-abdominal catastrophe and managed with damage control celiotomy. To accomplish early definitive abdominal closure, HADM was sewn in place as a fascial substitute; the skin and subcutaneous layers were approximated over silicone drains. The five patients ranged in age from 1 month to 19 years at the time of presentation. Intra-abdominal catastrophes included complex bowel injuries after blunt trauma in two children, necrotizing pancreatitis and gastric perforation in one teenager, necrotizing enterocolitis in one premature infant, and perforated typhlitis in one adolescent. All damage control wounds were dirty. Time range from initial celiotomy to definitive abdominal closure was 6 to 9 days. After definitive closure, one child developed a superficial wound infection. No patient developed a ventral hernia. After damage control celiotomy in children, early abdominal wall closure using HADM may minimize complications associated with delayed closure techniques and the need for additional procedures.

Download Full-text

Open abdomen management: single institution experience

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912015002005 ◽

2015 ◽

Vol 42 (2) ◽

pp. 93-96 ◽

Cited By ~ 1

Author(s):

Adilson Costa Rodrigues Junior ◽

Fernando da Costa Ferreira Novo ◽

Rafael de Castro Santana Arouca ◽

Francisco de Salles Collet e Silva ◽

Edna Frasson de Souza Montero ◽

...

Keyword(s):

Abdominal Wall ◽

Statistical Significance ◽

Fascial Closure ◽

Temporary Abdominal Closure ◽

Inclusion Criteria ◽

Single Institution ◽

Abdominal Closure ◽

The Difference ◽

Mean Time ◽

De Medicina

OBJECTIVE: to evaluate the outcome of abdominal wall integrity of both techniques. METHODS: a retrospective study was carried out at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, identifying the patients undergoing temporary abdominal closure (TAC) from January 2005 to December 2011. Data were collected through the review of clinical charts. Inclusion criteria were indication of TAC and survival to definitive abdominal closure. In the post-operative period only a group of three surgeons followed all patients and performed the reoperations. RESULTS: Twenty eightpatients were included. The difference in primary closure rates and mean time for fascial closure did not reach statistical significance (p=0.98 and p=0.23, respectively). CONCLUSION: VAC and Bogota Bag do not differ significantly regarding the outcome of abdominal wall integrity, due to the monitoring of a specific team and the adoption of progressive closure

Download Full-text

Standard Urine Collection Bag as an Improvised Bogotá Bag as a Temporary Abdominal Closure Method in an Open Abdomen in Preventing Abdominal Compartment Syndrome

Case Reports in Surgery ◽

10.1155/2021/6689000 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Ahmed Shabhay ◽

Zarina Shabhay ◽

Kondo Chilonga ◽

David Msuya ◽

Theresia Mwakyembe ◽

...

Keyword(s):

Compartment Syndrome ◽

Abdominal Wall ◽

Abdominal Compartment Syndrome ◽

Open Abdomen ◽

Anterior Abdominal Wall ◽

Temporary Abdominal Closure ◽

Urine Collection ◽

Abdominal Closure ◽

Closure Method ◽

Abdominal Compartment

Primary abdominal wall closure post laparotomy is not always possible. Certain surgical pathologies such as degloving anterior abdominal wall trauma injuries and peritoneal visceral volume and cavity disproportion render it nearly impossible for the attending surgeon to close the abdomen in the first initial laparotomy. In such surgical clinical scenarios leaving the abdomen open might be lifesaving. Forceful closure might lead to abdominal compartment syndrome and impair respiratory status of the patient. Open abdomen closure techniques have evolved over time from protection of abdominal viscera to complex fascia retraction prevention techniques. Silo bags, i.e., (Bogotá Bags), are relatively cheap, available materials used as a temporary abdominal closure method in limited resources settings. Despite its limitations of not preventing fascia retraction and draining of peritoneal fluid, it protects the abdominal viscera. We report a case of a 29-year-old male who developed incisional anterior abdominal wall wound dehiscence. He was scheduled for emergency explorative laparotomy. Intraoperatively, multiple attempts to reduce grossly dilated edematous bowels into the peritoneal cavity and fascia approximation into the midline were not possible. A urinary collection bag was sutured on the skin edges as a temporary abdominal closure method in prevention of abdominal compartment syndrome. He fared well postoperatively and eventually underwent abdominal incisional wound closure. In emergency abdominal surgeries done in limited surgical material resource settings were primary abdominal closure is not possible at initial laparotomy, sterile urine collection bags as alternatives to the standard Bogota bags as temporary abdominal closure materials can be safely used. These are relatively easily available and can be safely used until definite surgical intervention is achieved with relatively fewer complications.

Download Full-text

Open Abdomen Treatment for Septic Patients with Gastrointestinal Fistula: From Fistula Control to Definitive Closure

The American Surgeon ◽

10.1177/000313481408000414 ◽

2014 ◽

Vol 80 (4) ◽

pp. 339-347 ◽

Cited By ~ 12

Author(s):

Jianan Ren ◽

Yujie Yuan ◽

Yunzhao Zhao ◽

Guosheng Gu ◽

Gefei Wang ◽

...

Keyword(s):

Open Abdomen ◽

Abdominal Wall Reconstruction ◽

Fascial Closure ◽

Wound Complications ◽

Temporary Abdominal Closure ◽

Gastrointestinal Fistula ◽

Operative Strategy ◽

Abdominal Infection ◽

Abdominal Closure ◽

Intra Abdominal Infection

The use of open abdomen in the management of gastrointestinal fistula complicated with severe intra-abdominal infection is uncommon. This study was designed to evaluate outcomes of our staged approach for the infected open abdomen. Patients who had gastrointestinal fistula and underwent open abdomen treatment were retrospectively reviewed. Various materials such as polypropylene mesh and a modified sandwich package were used to achieve temporary abdominal closure followed by skin grafting when the granulation bed matured. A delayed definitive operation was performed for final abdominal closure without implant of prosthetic mesh. Between 1999 and 2009, 56 (68.3%) of 82 patients survived through this treatment. Among them, 42 patients achieved final abdominal closure. Spontaneous fistula closure occurred in 16 patients with secondary fistula recorded in six patients. Besides, wound complications occurred in 13 patients with two cases for pulmonary infection. Within a 12-month follow-up period after definitive closure, no additional fistula was recorded excluding planned ventral hernia repair. Open abdomen treatment was effective for gastrointestinal fistula complicated by severe intra-abdominal infection. A delayed and deliberate operative strategy aiming at fistula excision and fascial closure, with simultaneous abdominal wall reconstruction, was required for the infected open abdomen.

Download Full-text