Use of dynamic wound closure system in conjunction with vacuum-assisted closure therapy in delayed closure of open abdomen

Abstract

Abdominal re-approximation anchor system and VAC dressing can be used separately or in conjunction with each other for closure of delayed open abdomen successfully.

Management of the open abdomen using combination therapy with ABRA and ABThera systems

“…In our experience as well as other authors', it is usually apparent 4-7 days after placement of the ABThera that the fascia retracts further and will likely not close with the ABThera alone. 10,17 Although the reason for using an ABRA in addition to the ABThera was not recorded in our series, surgeons typically choose to use the ABRA in patients in whom they feel the fascia is unlikely to close with the ABThera alone. Consequently, we hypothesize that if the ABThera had been used without the ABRA, a primary fascial closure rate of less than 70% would have been observed in these patients.…”

“…It is possible that primary fascial closure may have been possible in this patient as well if more time had been given with the ABRA, as successful closure has been reported at up to 31 days in our study and 62 days in other studies involving the ABRA. [10][11][12] Achieving primary fascial closure avoids the morbidity of a ventral hernia and a second operation to repair it. However, the prolonged use of the ABRA to achieve primary closure comes at the cost of ongoing ABThera changes and increased length of stay in hospital.…”

“…Four case series have previously demonstrated the ABRA's efficacy in achieving fascial closure in the open abdomen. [10][11][12][13] Although combined therapy using the ABThera and the ABRA seems ideal to manage patients who may not achieve primary fascial closure with ABThera alone, this has not been previously described.…”

Prospective Assessment of the Negative Pressure Wound Therapy of the Open Abdomen

“…7 In this paper we assessed prospectively 27 patients, after continuation No matter what type of sequential mechanism for closure of OA is used, whether these are dynamic compression sutures (DCS), static compression sutures (SCS), polypropylene meshes in terms of SMAC -sandwich mesh abdominal closure, 10 or commercially made systems (ABRA system, Canica Medical Products Inc., Ontario, Canada), they showed significantly higher ratio of possible fascia closure in patients with OA. [11][12][13][14][15][16][17][18][19] In our group the most commonly used fixation were static sutures (37.5%), in 39.5% of patients no fixation was used. If considering relative numbers, more than half of the patients with ACS (26% of all patients) had no fixation.…”

“Acute postoperative open abdominal wall”: Nosological concept and treatment implications

“…In addition, several types of extracellular matrix-derived biological implants have been used [26,27] , although they are not recommended to bridge a fascial defect, and the long-term durability and functional outcome of biological implants is still unknown [28] . Other techniques for progressive closure of the abdominal wall, in combination or not with NPWT, include dynamic wound closure systems based on continuous dynamic tension to achieve re-approximation of the fascial edges of the abdominal wall [29,30] or the use of patches of synthetic material as a temporary, gradual means for abdominal closure [31] ; (3) Patients beyond the 2-3 wk window without progress towards closure or improvement of general condition and interstitial edema ("frozen abdomen") and without bowel fistulization. In these cases, the treatment options include skin cover over the defect or allow wound granulation (absorbable synthetic mesh implant, NPWT) and thereafter cover with skin grafts and subsequent definitive delayed closure (after 6-12 mo) in the context of a "planned" incisional hernia repair [32][33][34][35][36][37] ; and (4) Patients with enteroatmospheric fistula.…”