title: A prospective, controlled evaluation of the abdominal reapproximation anchor abdominal wall closure system in combination with VAC therapy compared with VAC alone in the management of an open abdomen.
abstract: Dramatic increases in damage control and decompressive laparotomies and a significant increase in patients with open abdominal cavities have resulted in numerous techniques to facilitate fascial closure. We hypothesized addition of the abdominal reapproximation anchor system (ABRA) to the KCI Abdominal Wound Vac™ (VAC) or KCI ABThera™ would increase successful primary closure rates and reduce operative costs. Fourteen patients with open abdomens were prospectively randomized into a control group using VAC alone (control) or a study group using VAC plus ABRA (VAC-ABRA). All patients underwent regular VAC changes; patients receiving VAC-ABRA also underwent concomitant daily elastomer adjustment of the ABRA system. Primary end points included abdominal closure, number of operating room (OR) visits, and OR time use. Eight patients were included in the VAC-ABRA group and six patients in the control group. Primary closure rates between groups were not statistically different; however, the number of trips to the OR and OR time use were different. Despite higher Acute Physiology and Chronic Health Evaluation II scores, larger starting wound size, and higher rates of abdominal compartment syndrome, closure rates in the VAC-ABRA group were similar to VAC alone. Importantly, however, fewer OR trips and less OR time were required for the VAC-ABRA group.
authors.affiliation: Division of General Surgery-Trauma and Critical Care, Department of Surgery, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Long
authors.forename: David A
authors.initials: DA
authors.lastname: Hamilton
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Davenport
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Bernard
authors.forename: Paul A
authors.initials: PA
authors.lastname: Kearney
authors.forename: Phillip K
authors.initials: PK
authors.lastname: Chang
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D059325:Intra-Abdominal Hypertension / Q000601:surgery*; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D011446:Prospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D016896:Treatment Outcome