title: Early aggressive closure of the open abdomen.
abstract: BACKGROUND
  The aim of this series is to describe a new and aggressive approach to definitive closure of the open abdomen.
  
  
  METHODS
  A retrospective review of 37 patients who underwent definitive abdominal closure using a combination of vacuum pack, vacuum-assisted wound management and human acellular dermal matrix (HADM).
  
  
  RESULTS
  All patients' open abdomens were maintained with vacuum assisted wound management in attempts for primary closure. Once it was determined that the abdomen would not close primarily; it was closed with HADM and skin advancement. The mean duration of the open abdomen was 21.7 days (range 6-45), with an average of 127.78 cm of HADM, the largest number being 800 cm, with decreasing use of product later in the series. No major complications were seen with the repair. Superficial wound infection occurred with two patients that were easily treated with wet to dry dressing changes. No intraabdominal complications such as fistula or graft loss were seen. All patients left the hospital with an intact abdominal wall and skin. All 37 patients survived to discharge and were seen in follow-up within one month. No early hernia formation was seen at the one month follow up with the longest at three years. No abdominal wall complications were seen in subsequent follow up patients.
  
  
  CONCLUSIONS
  Early aggressive closure of the open abdomen is possible with a combination of vacuum pack, vacuum-assisted wound management and HADM. Short term results are promising and warrant further study.
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza #404D, Houston, TX 77030, USA. bgscott@bcm.tmc.edu
authors.forename: Bradford G
authors.initials: BG
authors.lastname: Scott
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Welsh
authors.forename: Hoang Q
authors.initials: HQ
authors.lastname: Pham
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Carrick
authors.forename: Kathleen R
authors.initials: KR
authors.lastname: Liscum
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Granchi
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Wall
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Mattox
authors.forename: Asher
authors.initials: A
authors.lastname: Hirshberg
mesh_terms: D000007:Abdominal Injuries / Q000601:surgery*; D034861:Abdominal Wall / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D001672:Biocompatible Materials; D003094:Collagen; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000601:surgery*
chemical_list: C440568:Alloderm; D001672:Biocompatible Materials; D003094:Collagen