title: Closure of the open abdomen.
abstract: The open abdomen is a valuable tool in the management of patients with intra-abdominal hypertension and abdominal compartment syndrome. The longer an abdomen is left open, the greater the potential morbidity, however. From the very start, specific measures should be considered to increase  the likelihood of definitive closure and prevent the development of visceral adhesions, lateralization, and/or loss of skin and fascia, ileus, fistulae, and malnutrition. Early definitive closure of all abdominal wall layers is the short-term goal of management once the need for the open abdomen  has resolved. Several devices and strategies improve the chances for definitive closure. If a frozen abdomen develops, split-thickness skin grafting of a granulating open abdominal wound base is an alternative. Early coverage of the exposed viscera and acceptance of a large abdominal hernia  permit earlier reversal of the catabolic state and lower the risk of fistula formation. When a stoma is required, sealing and separation can become problematic. If a fistula develops, a more complex situation prevails, requiring specific techniques to isolate its output and a longer-term strategy  to restore intestinal continuity. Planning the closure of an open abdomen is a process that starts on the first day that the abdomen is opened. Multiple factors need to be addressed, optimized, and controlled to achieve the best outcome.
authors.affiliation: Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Uppsala, Sweden. martin@bjorck.pp.se
authors.forename: Martin
authors.initials: M
authors.lastname: Björck
authors.forename: Scott K
authors.initials: SK
authors.lastname: D'Amours
authors.forename: A E Ricardo
authors.initials: AE
authors.lastname: Hamilton
mesh_terms: D034841:Abdominal Cavity / Q000601:surgery; D034861:Abdominal Wall / Q000601:surgery*; D058107:Abdominal Wound Closure Techniques; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications; D054047:Surgical Stomas