Fluid volume overload negatively influences delayed primary facial closure in open abdomen management.
OBJECTIVE
The open abdomen (OA) is associated with significant morbidity and mortality, and its management poses a formidable challenge. Inability to achieve primary closure of the abdominal wall is one of the most severe complications of this technique. Factors influencing primary fascial closure, however, are unknown. This study aims to explore the influence of fluid volume overload on the application of vacuum-assisted and mesh-mediated fascial traction (VAWCM) in OA treatment.


METHODS
A review of patients undergoing OA management using VAWCM technique from January 2006 to November 2011 was performed. Patients with aged <18 y OA treatment for fewer than 5 d and abdominal wall hernia before OA treatment were excluded.


RESULTS
Average age was 45 ± 10.1 y and average OA treatment time was 31 ± 6.8 d. The complete fascial closure rate was 60%. The overall mean bodyweight-based fluid overload was 7.2 kg (range: -8.0 to +21.6 kg), representing a mean percent weight gain of 11.5% (range: -9.5% to +27%). Patients with fluid-related weight gain ≥10% had a lower primary facial closure rate than those with <10% (39% versus 77%). And primary facial closure rate seems to further decrease with fluid-related weight gain ≥20%, suggesting a dose-response effect of progressive fluid accumulation.


CONCLUSIONS
The VAWCM method provided a high primary fascial closure rate after long-term treatment of OA. Fluid volume overload negatively influences delayed primary facial closure. Judicious intravenous fluid resuscitation should be advocated in the therapy of critically ill patients.
Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China. Electronic address: doctorhq@163.com.
Qian
Q
Huang
Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China.
Risheng
R
Zhao
Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China.
Chao
C
Yue
Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China.
Wei
W
Wang
Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China.
Yunzhao
Y
Zhao
Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China.
Jianan
J
Ren
Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China.
Ning
N
Li
Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China.
Jie shou
Js
Li
D018806:APACHE; D000005:Abdomen / Q000601:surgery; D058107:Abdominal Wound Closure Techniques; D000328:Adult; D005205:Fascia / Q000502:physiology; D000071938:Fasciotomy; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects*; D006555:Hernia, Ventral / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D010195:Pancreatitis / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D013526:Surgical Mesh; D014883:Water-Electrolyte Imbalance / Q000150:complications* / Q000401:mortality; D014945:Wound Healing / Q000502:physiology*
Delayed primary facial closure; Fluid volume overload; Open abdomen; Vacuum-assisted and mesh-mediated fascial traction