title: Systematic review and evidence based recommendations for the use of negative pressure wound therapy in the open abdomen.
abstract: BACKGROUND
  Negative Pressure Wound Therapy (NPWT) is widely used in the management of the open abdomen despite uncertainty regarding several aspects of usage. An expert panel was convened to develop evidence-based recommendations describing the use of NPWT in the open abdomen.
  
  
  METHODS
  A systematic review was carried out to investigate the efficacy of a range of Temporary Abdominal Closure methods including variants of NPWT. Evidence-based recommendations were developed by an International Expert Panel and graded according to the quality of supporting evidence.
  
  
  RESULTS
  Pooled results, in non-septic patients showed a 72% fascial closure rate following use of commercial NPWT kits in the open abdomen. This increased to 82% by the addition of a 'dynamic' closure method. Slightly lower rates were showed with use of Wittmann Patch (68%) and home-made NPWT (vac-pack) (58%). Patients with septic complications achieved a lower rate of fascial closure than non-septic patients but NPWT with dynamic closure remained the best option to achieve fascial closure. Mortality rates were consistent and seemed to be related to the underlying medical condition rather than being influenced by the choice of dressing, Treatment goals for open abdomen were defined prior to developing eleven specific evidence-based recommendations suitable for different stages and grades of open abdomen.
  
  
  CONCLUSIONS
  The most efficient temporary abdominal closure techniques are NPWT kits with or without a dynamic closure procedure. Evidence-based recommendations will help to tailor its use in a complex treatment pathway for the individual patient.
authors.affiliation: Department of Trauma and Visceral Surgery, Luzern, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Bruhin
authors.affiliation: Hospital Pedro Hispano, Matosinhos-Porto, Portugal.
authors.forename: F
authors.initials: F
authors.lastname: Ferreira
authors.affiliation: Aesthetic Plastic Surgery Institute, Louisville, KY, USA.
authors.forename: M
authors.initials: M
authors.lastname: Chariker
authors.affiliation: Smith & Nephew, Hull, UK. Electronic address: jennifer.smith@smith-nephew.com.
authors.forename: J
authors.initials: J
authors.lastname: Smith
authors.affiliation: Department of General Surgery, Black Forest Hospital, Villingen-Schwenningen, Germany; University of Freiburg, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Runkel
mesh_terms: D000005:Abdomen / Q000601:surgery*; D058107:Abdominal Wound Closure Techniques; D001458:Bandages; D000071938:Fasciotomy; D005402:Fistula / Q000628:therapy; D006097:Granulation Tissue; D006801:Humans; D054843:Negative-Pressure Wound Therapy; D000267:Tissue Adhesions / Q000517:prevention & control; D014945:Wound Healing
keywords: Evidence-based recommendations; Negative Pressure Wound Therapy (NPWT); Open abdomen; Systematic review; Temporary abdominal closure