The two-stage concept with temporary subcutaneous implantation of a vacuum sealing system: an alternative surgical approach in infected partial abdominal defects after lapratomy or abdominoplasty.
BACKGROUND
Infected abdominal defects after laparatomy or abdominoplasty may present serious complications. The management of a progressive infection in the abdominal region with partial necrosis -without peritoneal irritation - is treated variously. Multiple revisions due to re-infection or seroma are often necessary. The different surgical treatment options almost always necessitate an extended immobilisation and hospitalisation of the patient.


METHODS
In five patients with infected partial abdominal defects after abdominoplasty (n = 3) or laparatomy (n = 2) successful management of infection was achieved in a two stages with temporary subcutaneous implantation of a polyurethane foam, combined with a vacuum assisted wound closure device, followed by secondary wound closure. In the first step a debridement, subcutaneous implantation of the foam, combined with intermittent subathmospheric pressure through a V.A.C. device was performed. In the second step an explantation of the foam, re-debridement and secondary wound closure was possible over 2 - 4 drains.


RESULTS
In all patients - after a temporary immobilisation of 5 days, and systemic antibiotic administration - wound healing was achieved. In one diabetic patient another single revision was necessary, because of the necrosis of a distal wound edge. The mean hospitalisation after application of these procedures was 15 days (12 - 19).


CONCLUSIONS
The surgical treatment of infected partial abdominal defects after laparatomy or abdominoplasty - performed in a two-stage procedure with temporary subcutaneous implantation of a V.A.C.-system, and secondary wound closure, offers a high level of safety, and presents an useful alternative tool in the difficult management of these patients.
Cedidi
C
C
Clinic for Plastic- and Hand Surgery - Aesthetic and Reconstructive Surgery, Klinikum Wuppertal - University Witten-Herdecke, Germany. cedidi@klinikum-wuppertal.de
Berger
A
A
Ingianni
G
G
D000009:Abdominal Muscles / Q000601:surgery*; D000328:Adult; D000368:Aged; D003646:Debridement / Q000379:methods; D004322:Drainage / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011140:Polyurethanes / Q000627:therapeutic use*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013529:Surgical Wound Dehiscence / Q000628:therapy*; D013530:Surgical Wound Infection / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome; D014945:Wound Healing
D011140:Polyurethanes