Fascia-to-fascia closure with abdominal topical negative pressure for severe abdominal infections: preliminary results in a department of general surgery and intensive care unit.
BACKGROUND
Vacuum-assisted fascial closure (VAFC-KCI(®)) of an open abdomen is one of the latest methods.


METHODS
A prospective observational study was performed with medical records of nine patients who had been treated by abdominal VAFC-KCI(®) from March 2006 to October 2007 in the Department of Surgical Sciences, University of Insubria. The mean Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores were 22.62 and 10.62, respectively. All patients had abdominal compartment syndrome and a sepsis source that was difficult to control.


RESULTS
All patients survived. The mean duration of open abdomen was 22.7 days (range, 3-50 days). Primary fascial closure was possible in six patients (66%), with a closure rate of 100% when early control of the infectious source was possible (Group A) but only 40% in patients with difficult and delayed control of infection (Group B). The mean durations of open abdomen in the two groups were statistically different: 8.5 days for Group A vs. 34.2 days for Group B (p < 0.005; Student t-test).


CONCLUSIONS
In our brief experience, VAFC-KCI(®) seems to be associated with a high fascial closure rate. The complexity of the management of abdominal source control has a role in the success of primary fascial closure. The VAFC-KCI(®) system seems to contribute positively in fascia-to-fascia abdominal closure in cases of severe abdominal infection, in particular when early surgical source control is obtained.
Department of General Surgery, University of Milano, Monza, Italy. pietro.pad@tiscali.it
Pietro
P
Padalino
Gianlorenzo
G
Dionigi
Giulio
G
Minoja
Giulio
G
Carcano
Francesca
F
Rovera
Luigi
L
Boni
Renzo
R
Dionigi
D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000071938:Fasciotomy; D013502:General Surgery; D006801:Humans; D006874:Hydrostatic Pressure; D007362:Intensive Care Units; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000517:prevention & control; D016019:Survival Analysis; D016896:Treatment Outcome; D058106:Wound Closure Techniques; D014945:Wound Healing