Matching Biological Mesh and Negative Pressure Wound Therapy in Reconstructing an Open Abdomen Defect

Caviggioli, Fabio; Klinger, Francesco; Lisa, Andrea; Maione, Luca; Forcellini, Davide; Vinci, Valeriano; Codolini, Luca; Klinger, Marco

doi:10.1155/2014/235930

Cited by 15 publications

(11 citation statements)

References 10 publications

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“…As a consequence, non-cross-linked BP should be used in a sublay position (i.e., with linea alba closure) and cross-linked ones should be preferred when the fascial bridge is needed [ 128 – 130 ]. BP could also tolerate adjunctive NPWT to facilitate wound healing, granulation, and skin closure [ 131 – 133 ].…”

Section: Methodsmentioning

confidence: 99%

The open abdomen in trauma and non-trauma patients: WSES guidelines

et al. 2018

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Damage control resuscitation may lead to postoperative intra-abdominal hypertension or abdominal compartment syndrome. These conditions may result in a vicious, self-perpetuating cycle leading to severe physiologic derangements and multiorgan failure unless interrupted by abdominal (surgical or other) decompression. Further, in some clinical situations, the abdomen cannot be closed due to the visceral edema, the inability to control the compelling source of infection or the necessity to re-explore (as a “planned second-look” laparotomy) or complete previously initiated damage control procedures or in cases of abdominal wall disruption. The open abdomen in trauma and non-trauma patients has been proposed to be effective in preventing or treating deranged physiology in patients with severe injuries or critical illness when no other perceived options exist. Its use, however, remains controversial as it is resource consuming and represents a non-anatomic situation with the potential for severe adverse effects. Its use, therefore, should only be considered in patients who would most benefit from it. Abdominal fascia-to-fascia closure should be done as soon as the patient can physiologically tolerate it. All precautions to minimize complications should be implemented.

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Section: Methodsmentioning

confidence: 99%

The open abdomen in trauma and non-trauma patients: WSES guidelines

et al. 2018

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“…Caviggioli et al reported on a patient with a complicated history of peritonitis. An enterocutaneous fistula was created due to enteric leakage [ 91 ]. A large defect of the abdominal wall was reconstructed using a porcine cross-linked mesh.…”

Section: Methodsmentioning

confidence: 99%

What is the evidence for the use of biologic or biosynthetic meshes in abdominal wall reconstruction?

Köckerling

Alam

Antoniou

et al. 2018

Hernia

136

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IntroductionAlthough many surgeons have adopted the use of biologic and biosynthetic meshes in complex abdominal wall hernia repair, others have questioned the use of these products. Criticism is addressed in several review articles on the poor standard of studies reporting on the use of biologic meshes for different abdominal wall repairs. The aim of this consensus review is to conduct an evidence-based analysis of the efficacy of biologic and biosynthetic meshes in predefined clinical situations.MethodsA European working group, “BioMesh Study Group”, composed of invited surgeons with a special interest in surgical meshes, formulated key questions, and forwarded them for processing in subgroups. In January 2016, a workshop was held in Berlin where the findings were presented, discussed, and voted on for consensus. Findings were set out in writing by the subgroups followed by consensus being reached. For the review, 114 studies and background analyses were used.ResultsThe cumulative data regarding biologic mesh under contaminated conditions do not support the claim that it is better than synthetic mesh. Biologic mesh use should be avoided when bridging is needed. In inguinal hernia repair biologic and biosynthetic meshes do not have a clear advantage over the synthetic meshes. For prevention of incisional or parastomal hernias, there is no evidence to support the use of biologic/biosynthetic meshes. In complex abdominal wall hernia repairs (incarcerated hernia, parastomal hernia, infected mesh, open abdomen, enterocutaneous fistula, and component separation technique), biologic and biosynthetic meshes do not provide a superior alternative to synthetic meshes.ConclusionThe routine use of biologic and biosynthetic meshes cannot be recommended.

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“…The difference between polyester and polypropylene is still under debate [163–165]. The affinity of different meshes to bacteria has also been studied, and it is established that microporous and multifilament meshes do have a higher affinity for bacterial contamination [165, 166] (EL 2).…”

Section: Resultsmentioning

confidence: 99%

“Complex abdominal wall” management: evidence-based guidelines of the Italian Consensus Conference

Piccoli

Agresta²,

Attinà³

et al. 2018

Updates Surg

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To date, there is no shared consensus on a definition of a complex abdominal wall in elective surgery and in the emergency, on indications, technical details, complications, and follow-up. The purpose of the conference was to lay the foundations for a homogeneous approach to the complex abdominal wall with the primary intent being to attain the following objectives: (1) to develop evidence-based recommendations to define “complex abdominal wall”; (2) indications in emergency and in elective cases; (3) management of “complex abdominal wall”; (4) techniques for temporary abdominal closure. The decompressive laparostomy should be considered in a case of abdominal compartment syndrome in patients with critical conditions or after the failure of a medical treatment or less invasive methods. In the second one, beyond different mechanism, patients with surgical emergency diseases might reach the same pathophysiological end point of trauma patients where a preventive “open abdomen” might be indicated (a temporary abdominal closure: in the case of a non-infected field, the Wittmann patch and the NPWT had the best outcome followed by meshes; in the case of an infected field, NPWT techniques seem to be the preferred). The second priority is to create optimal both general as local conditions for healing: the right antimicrobial management, feeding—preferably by the enteral route—and managing correctly the open abdomen wall. The use of a mesh appears to be—if and when possible—the gold standard. There is a lot of enthusiasm about biological meshes. But the actual evidence supports their use only in contaminated or potentially contaminated fields but above all, to reduce the higher rate of recurrences, the wall anatomy and function should be restored in the midline, with or without component separation technique. On the other site has not to be neglected that the use of monofilament and macroporous non-absorbable meshes, in extraperitoneal position, in the setting of the complex abdomen with contamination, seems to have a cost effective role too. The idea of this consensus conference was mainly to try to bring order in the so copious, but not always so “evident” literature utilizing and exchanging the expertise of different specialists.

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Matching Biological Mesh and Negative Pressure Wound Therapy in Reconstructing an Open Abdomen Defect

Cited by 15 publications

References 10 publications

The open abdomen in trauma and non-trauma patients: WSES guidelines

The open abdomen in trauma and non-trauma patients: WSES guidelines

What is the evidence for the use of biologic or biosynthetic meshes in abdominal wall reconstruction?

“Complex abdominal wall” management: evidence-based guidelines of the Italian Consensus Conference

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