title: VAWCM-Instillation Improves Delayed Primary Fascial Closure of Open Septic Abdomen.
abstract: Background. Failure to achieve delayed primary fascial closure (DPFC) is one of the main complications of open abdomen (OA), certainly when abdominal sepsis is present. This retrospective cohort study aims to evaluate the effect of combined therapy of vacuum-assisted mesh-mediated fascial traction and topical instillation (VAWCM-instillation) on DPFC in the open septic abdomen. Methods. The patients with abdominal sepsis who underwent OA using VAWCM were included and divided into the instillation and noninstillation (control) groups. The DPFC rate and other outcomes were compared between the two groups. Results. Between 2007 and 2013, 73 patients with open septic abdomen were treated with VAWCM-instillation and 61 cases with VAWCM-only. The DPFC rate in the instillation group was significantly increased (63% versus 41%, P = 0.011). The mortality with OA was similar (24.6% versus 23%, P = 0.817) between the two groups. However, time to DPFC (P = 0.003) and length of stay in hospital (P = 0.022) of the survivals were significantly decreased in the instillation group. In addition, VAWCM-instillation (OR 1.453, 95% CI 1.222-4.927, P = 0.011) was an independent influencing factor related to successful DPFC. Conclusions. VAWCM-instillation could improve the DPFC rate but could not decrease the mortality in the patients with open septic abdomen.
authors.affiliation: Department of General Surgery, Affiliated Zhongda Hospital, Southeast University Medical School, 87 Dingjiaqiao, Nanjing, Jiangsu 210089, China.
authors.forename: Qingsong
authors.identifier: 0000-0002-3936-6005
authors.initials: Q
authors.lastname: Tao
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Nanjing University Medical School, 305 East Zhongshan Road, Nanjing, Jiangsu 210093, China.
authors.forename: Jianan
authors.identifier: 0000-0002-7978-8093
authors.initials: J
authors.lastname: Ren
authors.affiliation: Department of General Surgery, Affiliated Zhongda Hospital, Southeast University Medical School, 87 Dingjiaqiao, Nanjing, Jiangsu 210089, China.
authors.forename: Zhenling
authors.initials: Z
authors.lastname: Ji
authors.affiliation: Department of General Surgery, Affiliated Zhongda Hospital, Southeast University Medical School, 87 Dingjiaqiao, Nanjing, Jiangsu 210089, China.
authors.forename: Shengli
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of General Surgery, Affiliated Zhongda Hospital, Southeast University Medical School, 87 Dingjiaqiao, Nanjing, Jiangsu 210089, China.
authors.forename: Baochai
authors.initials: B
authors.lastname: Wang
authors.affiliation: Department of Surgery, Haian People's Hospital, Nantong University Medical School, 17 Zhongba Road, Nantong, Jiangsu 226600, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Nanjing University Medical School, 305 East Zhongshan Road, Nanjing, Jiangsu 210093, China.
authors.forename: Guosheng
authors.initials: G
authors.lastname: Gu
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Nanjing University Medical School, 305 East Zhongshan Road, Nanjing, Jiangsu 210093, China.
authors.forename: Xinbo
authors.initials: X
authors.lastname: Wang
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Nanjing University Medical School, 305 East Zhongshan Road, Nanjing, Jiangsu 210093, China.
authors.forename: Jieshou
authors.initials: J
authors.lastname: Li