Wittmann Patch Abdominal Closure

BACKGROUND: Although the 'open abdomen' has likely contributed to improved outcomes in trauma patients, the challenge of subsequent fascial closure has emerged. Since mid 2004, we have incorporated Wittmann Patch staged abdominal closure into our management of the open abdomen. The purpose of this study was to evaluate the impact of this device on our incidence of fascial closure versus planned ventral hernia. METHODS: Patients managed by open abdomen from 2001 through 2006 were identified from the trauma registry. Fascial closure immediately after definitive repair of injuries was defined as 'early fascial closure.' Continuation of the open abdomen beyond the definitive repair of injuries with subsequent fascial closure was defined as 'delayed fascial closure.'

Temporary Abdominal Closure Techniques: The Wittmann Patch. This method allows for reexploration of the abdomen as well as slow re-approximation of the. Fascial closure immediately after definitive repair of injuries was defined as 'early fascial closure.' Continuation of the open abdomen beyond the definitive repair of injuries with subsequent fascial closure was defined as 'delayed fascial closure.' Since April 2004, the Wittmann Patch was uniformly employed in open abdomen management.

Since April 2004, the Wittmann Patch was uniformly employed in open abdomen management. Patients managed before the use of this device ('pre-Patch') were compared with those managed in the 'Patch' era.

RESULTS: Fifty-six open abdomens were managed in the pre-Patch era and 103 were managed in the Patch era. In the pre-Patch era, 33 (59%) underwent early fascial closure, compared with 67 (65%) in the Patch era (p NS). Keygen crack. For the remaining patients, the incidence of delayed fascial closure was significantly higher in those managed with the Wittmann Patch compared with those managed in the pre-Patch era (78% vs.

T he infected abdomen poses substantial challenges to surgeons, and often, both temporary and definitive closure techniques are required. Temporary abdominal closure (TAC) allows surgeons ease of re-entry for multiple operations in an infected surgical field. Additionally, temporary closure helps reduce the risk of abdominal compartment syndrome (intra-abdominal hypertension) and its associated morbidity and mortality. Definitive reconstruction can be accomplished eventually in most cases through one of a variety of operative techniques. We review the multiple options available to close the abdominal wall defect satisfactorily during and after the management of complicated intra-abdominal infections. Intra-abdominal infection carries a substantial risk of death, depending largely on the intensity of the patient's systemic response and the extent of the physiologic response, often measured by the Acute Physiology and Chronic Health Evaluation (APACHE) II score. Mischievous kiss 3 episode 1.

The APACHE II score is a well-established and validated method by which to stratify risk in patients with intra-abdominal infections [,]. The goals of clinical management of intra-abdominal infections include control of bacterial or toxin sources, maintaining organ system function, and quelling the resultant inflammatory process []. Occasionally, multiple laparotomies are required to eradicate intra-abdominal bacterial sources. This approach should be undertaken only when definitive closure of the abdomen is not possible initially. Performing re-laparotomy on demand, compared with planned re-laparotomy, yields a higher rate of anastomotic leakage, lower incisional hernias, and all surgery-related complications (intra-abdominal abscess, fistula, hemorrhage, perforation) [].

In a sense, leaving the abdomen open in peritonitis is similar to the damage control approach for trauma. Leaving the abdomen open not only enables multiple operations but also helps prevent abdominal compartment syndrome. Perioperative fluid resuscitation of the patient leads frequently to visceral and retroperitoneal edema, ischemic fascia, and abdominal compartment syndrome. An intra-abdominal pressure >30 cm H 2O can result in decreased venous return and cardiac collapse, leading to multiple organ dysfunction syndrome, especially of the pulmonary, cardiovascular, renal, splanchnic, and central nervous systems (CNS).