Total management of the open abdomen

Abstract

The management of complex abdominal problems with the 'open abdomen' (OA) technique has become a routine procedure in surgery. The number of cases treated with an OA has increased dramatically because of the popularisation of damage control for life-threatening conditions, recognition and treatment of intra-abdominal hypertension and abdominal compartment syndrome and new evidence regarding the management of severe intra-abdominal sepsis. Although OA has saved numerous lives and has addressed many problems related to the primary pathology, this technique is also associated with serious complications. New knowledge about the pathophysiology of the OA and the development of new technologies for temporary abdominal wall closure (e.g. ABThera™ Open Abdomen Negative Pressure Therapy; KCI USA Inc., San Antonio, TX) has helped improve the management and outcomes of these patients. This review will merge expert physician opinion with scientific evidence regarding the total management of the OA.

Case Report Local skin flap with vacuum-seal drainage to facilitate healing of ACS

“…Surgical decompression or delay in closing the abdomen are generally recognized as effective measures for ACS (Balogh et al, 2007;Vidal et al, 2008;Björck, 2012;Demetriades, 2012). However, when and how to close the abdominal defect are difficult for surgeons in the emergency department to determine.…”

“…However, when and how to close the abdominal defect are difficult for surgeons in the emergency department to determine. Currently, widely accepted indications for when to attempt closure are as follows (Vidal et al, 2008;Björck, 2012;Demetriades, 2012): reduction of intra-abdominal pressure to a normal level, stability of hemodynamics, increase in urinary output, resolution of edema, and correction of coagulopathy. The opportunity for closure usually occurs approximately two weeks after surgery, but may occur later for severe ACS patients.…”

“…The procedures described provide a foundation for rehabilitation of severe multiple trauma patients. Once patients pass the critical stage of ACS, herniorrhaphy and other abdominal surgical techniques can completely repair abdominal wall defects (van Mook et al, 2002;Demetriades, 2012).…”

“…If intestinal edema has not completely resolved, an abdominal advanced flap is strongly suggested to replace the primary sutures. We separated the superficial fascia with an incision of the rectus and constructed a free fasciocutaneous flap to directly cover the bowel surface (Vidal et al, 2008;Demetriades, 2012). The advantages of this technology include the following: 1) to avoid a recurrence of ACS caused by IAH; 2) to temporarily expand the abdominal cavity to contain the intestines and close the abdominal wound; 3) to reduce the recurrence of ACS through the retaining fascia without suturing the rectus; 4) to increase feasibility of isolation of the skin flap from the front of the rectus sheath and muscle because of the thickened abdominal wall and clearly separated layers; and 5) to easily supplement the flap with a prosthetic patch to close the abdominal cavity if the free flap cannot be completely sutured.…”

Nonclinical, Observational Trauma Rotations in the United States provide International Students Multidisciplinary Trauma Program and Systems Education

“…12,13 The largest previously published cohort of pregnant women includes 28 cases, all of whom received packaging due to uncontrolled bleeding with temporary closure of the abdominal wall, reporting a maternal mortality rate of 35%. 14,15 Fundación Valle del Lili (FVL) is a private nonprofit hospital in Cali, Colombia, with an emphasis on the care of high-complexity patients. The High Complexity Unit (UACO) attends obstetric patients.…”