Staged Repair Of Severe Open Abdomens Due To High-Energy Gunshot Injuries With Early Vacuum Pack And Delayed Tissue Expansion And Dual-Sided Meshes

Abstract

Staged repair of severe open abdomens due to high-energy gunshot injuries with early vacuum pack and delayed tissue expansion and dual-sided meshes series of intra-abdominal interventions. At the end of this long treatment period, persistent intestinal edema and retraction of the abdominal wall are the main factors why fascias cannot be connected at an early time. Moreover, in severe abdominal traumas like the ones caused by high-energy gunshots, trauma may not only affect the intra-abdominal components but may also cause loss of domain of the abdominal wall.A staged reconstruction protocol is required for this type of patients. Firstly, a temporary closing of the viscera is provided, and subsequently, permanent repair of the abdominal wall should be done. Many procedures have been advocated to close the viscera at the first stage. [1][2][3][4][5][6] The fundamental principle in all of these procedures is forming the granulation tissue on the open abdominal wall and closing it with partial-thickness skin graft (PTSG ABSTRACT BACKGROUND: Open abdomen is a salvage procedure that prevents catastrophes after severe intraabdominal traumas. However, following this life saving attempt, it is mostly not feasible to close the abdomen immediately after the recovery of intraabdominal injuries. Consequently, a staged reconstruction is required, and the first stage is usually a temporary closing approach. At the end of this stage, resulting giant "ventral hernia" is a burden for both the patient and the surgeon. Therefore a permanent repair is subsequently needed. Although there are many treatment modalities described for this goal, etiologies like high-energy gunshots may cause an exactly nuisance scene which can limit treatment options and reduce final success. Herein, it was the objective of this study to present our staged protocol to restore the abdominal wall defect and strategy for optimizing the results in such conundrum cases. METHODS:Treatment was performed on nine male patients suffering from severe open abdomen due to high-energy gunshot injury. In all patients, temporary closure was provided by negative pressure wound treatment applied directly to the viscera and followed by skin grafting. Late permanent closure was performed with the lamination of expanded abdominal skin and dual-sided meshes. RESULTS:The follow-up period ranged between 24 months to 4.5 years (mean, 3 years). During this period, no recurrence of ventral hernia, enteric fistula formation, abdominal infection and seroma formation was observed in any patient. CONCLUSION:In this study, NPWT, tissue expansion and dual-sided mesh were used together as a staged procedure for optimizing the results in the clinical scenario of an open abdomen due to high-energy gunshot wound. Results were highly satisfactory for patients and acceptable aesthetically.