Delayed closure of open abdomen in septic patients is facilitated by combined negative pressure wound therapy and dynamic fascial suture

Abstract

Using a new technique combining NPWT and DFS in the treatment of the OA, the delayed closure of the fascial edges by running suture can be achieved and the number of re-operations can be kept low. The technique was safe and led to a low incidence of incisional hernias. Extensive abdominal wall reconstruction was seldom required.

Vacuum-assisted wound closure and mesh-mediated fascial traction for open abdomen therapy — a systematic review

“…A modified vacuum technique with successive closure of the fascia with non-resorbable single stitch sutures starting from the proximal to distal ends of the wound, called the narrowing technique, has also been described [21]. Although all these studies report a high fascial closure rate [16][17][18][19][20][21], none of these techniques has spread to a large number of independent researchers, such as the VAWCM technique. Moreover, none of these techniques has been evaluated regarding long-term outcome in terms of abdominal wall discomforts and quality of life.…”

“…The fascial traction force has consisted of # 1-polydioxanone suture sutures (PDS) [18], vessel loops as dynamic sutures [17,19,20] or a dynamic closure system called the abdominal reapproximation anchor system (ABRA) [16]. A modified vacuum technique with successive closure of the fascia with non-resorbable single stitch sutures starting from the proximal to distal ends of the wound, called the narrowing technique, has also been described [21].…”

“…Reviews, editorials, commentaries, abstracts without full text articles, case series < 5 patients, irrelevant articles, articles not in English and those duplicating the same population were excluded. Seventeen full-text articles remained for assessment of eligibility, of which six articles were excluded: Vacuum and controlled fascial traction was used, but not mesh-mediated (n = 5) [16][17][18][19][20], modified NPWT (n = 1) [21], VAWCM therapy initiated if complete fascial closure not could be obtained with VAWC alone (n = 1) [22] and if the primary fascial closure rate per protocol and open abdomen time were not reported (n = 1) [23] (Fig. 1 [24]).…”

Delayed closure of open abdomen in septic patients treated with negative pressure wound therapy and dynamic fascial suture: the long-term follow-up study

“…We recently published a prospective controlled trial of eighty-seven patients after abdominal surgery for secondary peritonitis between 2007 and 2012 [12]. Patients were treated with NPWT and DFS for approximation of fascial edges.…”

The heart of darkness

“…The authors of this editorial feel that this is one of the most important issues demanding clarification and recommendation. We sincerely believe that in most cases it is avoidable to use a mesh under such conditions if clinicians and patients can endure a lengthy treatment regimen [6]. We emphasize that a clean wound situation should be achieved before a final closure is attempted (this has been possible in most patients even after disastrous courses of closing an open abdomen after the prolonged treatment of secondary peritonitis).…”