Management of open abdominal wounds with a dynamic fascial closure system.
BACKGROUND
In damage-control surgery, definitive abdominal closure may not be possible for several days or weeks after laparotomy until the patient has stabilized.


METHODS
We present 23 patients treated with the Canica ABRA dynamic wound closure system that re-approximated open abdomens with silicone elastomers placed transfascially across the wound. This study aimed to assess the results of using this system and to identify risk factors for unsuccessful closure. The system maintains a medially directed force across the wound. A traditional regimen of wound dressing changes was performed.


RESULTS
The dynamic closure system remained in place an average of 48 days and was applied an average of 18 days after the beginning of treatment for the open abdominal wound. Delayed primary fascial closure was achieved in 14 of 23 patients (61%) without further surgery. Six patients (26%) healed with ventral hernias but with a smaller abdominal defect. Two patients (9%) developed enterocutaneous fistulae through the wound that required further surgery. An overall reduction in wound area of 95% was achieved.


CONCLUSIONS
This dynamic wound closure technique permitted the delayed primary closure of open abdomens in 61% of cases when treatment was instituted an average of 18 days after initial laparotomy.
Reimer
Mark W
MW
Department of General Surgery, the Ottawa Hospital, Ottawa, Ont. mwreimer@biologicalprocedures.com
Yelle
Jean-Denis
JD
Reitsma
Bert
B
Doumit
Gaby
G
Allen
Murray A
MA
Bell
Michael S
MS
D000007:Abdominal Injuries / Q000601:surgery*; D034861:Abdominal Wall / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D000071938:Fasciotomy; D005260:Female; D006555:Hernia, Ventral / Q000453:epidemiology; D006801:Humans; D007412:Intestinal Fistula / Q000453:epidemiology; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012826:Silicone Elastomers; D050151:Subcutaneous Fat / Q000601:surgery; D013537:Sutures; D013718:Tensile Strength; D013997:Time Factors
D012826:Silicone Elastomers