Delayed Closure of 61 Open Abdomen Patients Based on an Algorithm

Abstract

Hemodynamic resuscitation, source control, and delayed abdominal closure are the three fundamental steps for open abdomen (OA) management. When to start delayed abdominal closure and how to determine which delayed closure method should be applied to each OA patient are not clarified in the literature. We evaluated an algorithm that was developed to address these two questions. A retrospective chart review was conducted for OA patients treated for according to the algorithm. When hemodynamic stabilization and source control using negative pressure therapy resulted in regression of sepsis and decreased procalcitonin levels, patients were assigned to either the skin-only or fascial closure groups according to their Björck scores and open abdominal fascial closure (OAFC) scores. The novel OAFC scoring system was created by adding age and malignancy to the sequential organ failure assessment (SOFA) score. For skin-only closure, skin flaps and skin grafts were used; for fascial closure, an abdominal re-approximation anchor system (ABRA) or ABRA plus biologic mesh was applied. From January 2008 through September 2014, 108 OA patients were managed based on the algorithm; 61 were included in this study. Abdominal closure rate was 90.2 % (55/61). Overall hospital mortality rate was 11.4 % (7/61). Small hernias developed in only 12.5 % (4/32) of the fascial closure group. In this retrospective study, the algorithm with the novel OAFC score provided practical and valid guidance to clarify when to start delayed abdominal closure and which delayed closure method to use for each OA patient.

Dynamic closure techniques for treatment of an open abdomen: an update

“…In total, 13 studies fulfilled the criteria [12][13][14][15][16][17][18][19][20][21][22][23][24]. All included studies are observational cohort studies, and no studies reported on the use of either the Wittmann patch or the ABRA system.…”

“…Two studies reported on the ABRA system in combination with NPWT [12,13], while 9 reported on meshmediated fascial traction (MMFT) combined with NPWT [14][15][16][17][18][19][20][21][22]. Other types of fascial traction, either by dynamic suture lines [23] or by a self-made silastic tube system, and NPWT [24] were reported in 2 studies.…”

“…Considering dynamic closure using the ABRA system™, only two studies were found, of which one included only 12 patients [12], while Yetisir et al [13] only reported the abdominal wall closure rate of their surviving patients (55 out of 61 patients survived), not necessarily the fascial closure rate and also excluded the patients developing an EAF (n = 27/61), high Björck classification score (≥ 3), high age and malignancy, leaving them with a somewhat preselection of 'fitter patients' and a higher reported closure rate of 90.2%.…”

Intra-abdominal Pressure Monitoring in Open Abdomen Management with Dynamic Abdominal Closure

“…When NPT was combined with the strategies allowing reapproximation of the fascial edges, high closure rates can be achieved [15]. Use of mesh-mediated fascial traction methods may be more suitable in non-infected OA patients, whereas ABRA might be used in the severely infected OA patients in conjunction with NPT [16]. Dynamic traction adjusted continuously with ABRA in conjunction with NPT prevents fascial retraction, subscribes improvement in granulation tissue, allowing expansion and retraction during spontaneous respiratory cycle [3,4,17].…”

Predisposing Factors and Occurrence Rate of Incisional Hernia after Open Abdomen Management

“…Second one is the significant decrease in mortality rate of OA patients due to evolution in the delayed abdominal closure systems and intensive care unit (ICU) consideration. [3][4][5] As the number of surviving OA patients increases, management of some challenging sequels after OA treatment, such as incisional hernia (IH), constant or permanent stoma, entero-cutaneous fistula (ECF), short bowel syndrome, chronic organ failure and badly healed scar come into consideration. 4 Most important one of them is planned or unplanned IH.…”