title: Treatment options for postoperatively infected abdominal wall wounds healing by secondary intention.
abstract: OBJECTIVE
  We present our current clinical approach for the treatment of postoperatively infected wounds of the abdominal wall healing by secondary intention that may help in the design of a randomized controlled trial to develop a standardized wound treatment pathway.
  
  
  METHODS
  Patients with postoperatively infected abdominal wounds treated with either Advanced Wound Care (AWC) dressings or vacuum-assisted closure (VAC) therapy were enrolled in the study. Follow-up was carried out prospectively for wound healing and incidence of incisional hernia at the earliest 3 years after surgery.
  
  
  RESULTS
  Sixty-two patients were included and wounds were initially treated antiseptically for 5.19 ± 2.91 days. Prior to VAC therapy, AWC dressings were applied for 8.75 ± 2.93 days to reduce reinfection. Greater wound size (>12 × 6 × 6cm) and extensive secretion (>200 ml/day) argued for the VAC system. Overall incidence of incisional hernia was 20.4%, with 18.4% occurring in AWC-treated patients and 27.3% in VAC-treated patients. Based on these results, a wound treatment pathway was established in our department.
  
  
  CONCLUSIONS
  The established wound treatment pathway has helped to increase both workflow efficacy and outcome in the treatment of abdominal wounds. Wound size, amount of secretion, and status of infection were the parameters we used for the determination of appropriate treatment. The observational data gathered during the initiation of our pathway lay the basis for future randomized controlled trials that will determine the most appropriate treatment options in the setting of a standardized wound treatment pathway.
authors.affiliation: Department of General and Visceral Surgery, University Hospital of Münster, Waldeyerstr.1, 48149, Münster, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Mees
authors.forename: Wolf Arif
authors.initials: WA
authors.lastname: Mardin
authors.forename: Norbert
authors.initials: N
authors.lastname: Senninger
authors.forename: Matthias
authors.initials: M
authors.lastname: Bruewer
authors.forename: Daniel
authors.initials: D
authors.lastname: Palmes
authors.forename: Soeren Torge
authors.initials: ST
authors.lastname: Mees
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D001458:Bandages; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D013530:Surgical Wound Infection / Q000473:pathology / Q000628:therapy*; D014945:Wound Healing