title: Delayed closure of open abdomen in septic patients is facilitated by combined negative pressure wound therapy and dynamic fascial suture.
abstract: BACKGROUND
  The aim of this prospective controlled trial was the definition of the optimal timepoint for delayed closure after negative pressure wound therapy (NPWT) in the treatment of the open abdomen (OA) in septic patients after abdominal surgery. The delayed closure of the abdominal wall after abdominal NPWT treatment is often problematic due to the lateralization of the fascial edge leading to unfavorably high tensile forces of the adapting sutures in the midline. We present the results of an innovative combination of NPWT with a new fascial-approximation technique using dynamic fascial sutures (DFS) and delayed closure of the abdominal wall.
  
  
  METHODS
  Eighty-seven patients subjected to OA therapy following surgery for secondary peritonitis were treated with NPWT and DFS. In all patients, a running suture of elastic vessel loops was used to approximate fascial edges. This procedure was continued for the duration of NPWT until final closure of the abdomen with running suture in 55 patients (63.2 %) and interrupted suture technique in eight patients (9.2 %). An anterior component separation was performed in seven patients.
  
  
  RESULTS
  Delayed closure was achieved in 68 patients (78.2 %) after 12.6 days [mean (SD) 25.1 (2-204)] days and 4.3 re-operations [mean (SD) 6.0 (1-43)]. Fifteen (17.2 %) superficial and two (2.3 %) deep wound infections occurred. In three (3.4 %) cases, entero-atmospheric fistulas had to be treated. We recorded no technique-specific complications. Four (5.9 %) incisional hernia were detected in a mean follow-up of 40.5 months (16-65). Mortality rate was 55.2 %.
  
  
  CONCLUSIONS
  Using a new technique combining NPWT and DFS in the treatment of the OA, the delayed closure of the fascial edges by running suture can be achieved and the number of re-operations can be kept low. The technique was safe and led to a low incidence of incisional hernias. Extensive abdominal wall reconstruction was seldom required.
authors.affiliation: Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Montleartstrasse 37, 1171, Vienna, Austria, rene.fortelny@wienkav.at.
authors.forename: René H
authors.initials: RH
authors.lastname: Fortelny
authors.forename: Anna
authors.initials: A
authors.lastname: Hofmann
authors.forename: Simone
authors.initials: S
authors.lastname: Gruber-Blum
authors.forename: Alexander H
authors.initials: AH
authors.lastname: Petter-Puchner
authors.forename: Karl S
authors.initials: KS
authors.lastname: Glaser
mesh_terms: D000005:Abdomen / Q000601:surgery; D058107:Abdominal Wound Closure Techniques; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria / Q000453:epidemiology; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D010538:Peritonitis / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation; D018805:Sepsis / Q000209:etiology*; D013530:Surgical Wound Infection / Q000150:complications / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate / Q000639:trends; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome