title: Open abdomen treatment with dynamic sutures and topical negative pressure resulting in a high primary fascia closure rate.
abstract: BACKGROUND
  Open abdomen (OA) treatment with negative-pressure therapy is a novel treatment option for a variety of abdominal conditions. We here present a cohort of 160 consecutive OA patients treated with negative pressure and a modified adaptation technique for dynamic retention sutures.
  
  
  METHODS
  From May 2005 to October 2010, a total of 160 patients--58 women (36 %); median age 66 years (21-88 years); median Mannheim peritonitis index 25 (5-43) underwent emergent laparotomy for diverse abdominal conditions (abdominal sepsis 78 %, ischemia 16 %, other 6 %).
  
  
  RESULTS
  Hospital mortality was 21 % (13 % died during OA treatment); delayed primary fascia closure was 76 % in the intent-to-treat population and 87 % in surviving patients. Six patients required reoperation for abdominal abscess and five patients for anastomotic leakage; enteric fistulas were observed in five (3 %) patients. In a multivariate analysis, factors correlating significantly with high fascia closure rate were limited surgery at the emergency operation and a Björk index of 1 or 2; factors correlating significantly with low fascia closure rate were male sex and generalized peritonitis.
  
  
  CONCLUSIONS
  With the aid of initially placed dynamic retention sutures, OA treatment with negative pressure results in high rates of delayed primary fascia closure. OA therapy with the technical modifications described is thus considered a suitable treatment option in various abdominal emergencies.
authors.affiliation: Department of Visceral, Thorax and Transplant Surgery, University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. reinhold.kafka-ritsch@uki.at
authors.forename: Reinhold
authors.initials: R
authors.lastname: Kafka-Ritsch
authors.forename: Matthias
authors.initials: M
authors.lastname: Zitt
authors.forename: Nina
authors.initials: N
authors.lastname: Schorn
authors.forename: Sebastian
authors.initials: S
authors.lastname: Stroemmer
authors.forename: Stefan
authors.initials: S
authors.lastname: Schneeberger
authors.forename: Johann
authors.initials: J
authors.lastname: Pratschke
authors.forename: Alexander
authors.initials: A
authors.lastname: Perathoner
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015897:Comorbidity; D000071938:Fasciotomy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D011183:Postoperative Complications / Q000401:mortality; D012086:Reoperation; D013530:Surgical Wound Infection / Q000401:mortality; D013536:Suture Techniques; D016896:Treatment Outcome