Delayed primary closure in open abdomen with stoma using dynamic closure system

Abstract

BackgroundThe situation of abdominal sepsis secondary to colonic perforation sometimes forces treat the patient with multiple interventions in the open abdomen (OA) context. Correct management of OA is important to restore the patient’s clinical situation and to avoid further complications of the abdominal wall. Delayed primary closure of the abdomen using a dynamic and progressive traction is a relatively new technique for treating the OA.Case presentationWe report the case of a 50 year old woman with history of malnutrition and chronic obstructive pulmonary disease, affects for an OA after several surgical interventions. Two previous interventions (right colectomy, ileostomy and laparotomy with Bogotá bag) for disseminated peritonitis and abdominal compartment syndrome were performed. Six days after the Bogota bag the of the dynamic closure system ABRA® system was placed to delayed primary closure of the abdomen with excellent result results of the contingency of the abdominal wall.DiscussionThe most common technique in the current management of OA is the placement of vacuum-assisted closure or the use of a mesh. These systems generally require several operations to restore the integrity of the abdominal wall. However, the dynamic closure of the abdominal wall makes it possible to restore it into the same process.ConclusionsABRA system allows delayed primary closure of the abdominal wall in an OA by sepsis secondary to colonic perforation. The stoma was not a problem with this technique. The final closure of the abdomen was at 16 days after the ABRA placement. The abdominal wall has not alterations in the follow up after 3 years.

Stoma Retraction in Super-Morbidly Obese Patient Leading to Class IV Midline Wound: A Cautionary Tale

“…The ABRA DTS provides dynamic tension that facilitates relaxation of the flat muscles, thus allowing for the medialization of the rectus myofascial units utilizing elastomers and anchoring buttons (Figure 5). 9 The patient presented in this case study differs from those in previous literature due to the constellation of risk factors that complicated the patient's postoperative course. In addition to morbid obesity and stomal retraction, the patient had continuous wound contamination that necessitated multiple abdominal washouts which complicated her recovery.…”

“…The ABRA DTS provides dynamic tension that facilitates relaxation of the flat muscles, thus allowing for the medialization of the rectus myofascial units utilizing elastomers and anchoring buttons (Figure 5). 9…”

“…5,8 In addition to the management of stomal retraction, achieving definitive abdominal wall closure in patients with large open abdominal wounds can significantly reduce morbidity and mortality. 9 Injection of BTA into the lateral abdominal muscles is a novel technique used as a treatment adjunct for primary myofascial closure of the open abdomen. In the absence of an intact linea alba, the flat muscles are in a state of constant contraction which lateralizes the rectus myofascial units resulting in an acute open abdomen with or without loss of domain.…”