title: Vacuum-assisted closure for defects of the abdominal wall.
abstract: BACKGROUND
  Reconstruction of the abdominal wall poses a problem common to many surgical specialties. Abdominal wall defects may be caused by trauma and/or prior surgery, with dehiscence or infection. Several options to repair the structural integrity of the abdominal wall exist, including primary closure, flaps, mesh, and skin grafts. Complications of these procedures include recurrent infection of the abdominal wall, infection of mesh, dehiscence, flap death, and poor skin graft take. Risk factors predisposing to these complications include tissue edema, preoperative tissue infection, and patient debilitation, with poor wound healing potential. Ideally, reconstruction should be performed on a nonedematous, clean tissue bed with bacterial levels less than 10 bacteria/cm in a well-nourished patient.
  
  
  METHODS
  Vacuum-assisted closure was used in a series of patients in an attempt to prepare the abdominal wall for reconstruction and reduce the risk of complications. Charts were reviewed for 100 patients who underwent abdominal wall reconstruction after vacuum-assisted closure therapy. Their wound cause, reconstruction technique, complications, and number of days on the vacuum-assisted closure device are reported.
  
  
  RESULTS
  The ability of vacuum-assisted closure to reduce edema, increase blood flow, potentially decrease bacterial colonization, and reduce wound size greatly facilitated abdominal wall reconstruction. The vacuum-assisted closure device served as a temporary dressing with which to control dehiscence and to maintain abdominal wall integrity when bowel wall edema prevented abdominal closure.
  
  
  CONCLUSIONS
  Vacuum-assisted closure therapy frequently shortened time to abdominal wall reconstruction and simplified the method of reconstruction.
authors.affiliation: Winston-Salem, N.C. From the Departments of Plastic and Reconstructive Surgery and General Surgery, Wake Forest University School of Medicine.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: DeFranzo
authors.forename: Keith
authors.initials: K
authors.lastname: Pitzer
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Molnar
authors.forename: Malcolm W
authors.initials: MW
authors.lastname: Marks
authors.forename: Michael C
authors.initials: MC
authors.lastname: Chang
authors.forename: Preston R
authors.initials: PR
authors.lastname: Miller
authors.forename: Robert W
authors.initials: RW
authors.lastname: Letton
authors.forename: Louis C
authors.initials: LC
authors.lastname: Argenta
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009779:Occlusive Dressings; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D014618:Vacuum; D014947:Wounds and Injuries / Q000601:surgery*