title: A novel technique for managing open abdomen with the combined use of mesh-mediated traction and the bilateral anterior rectus abdominis sheath turnover flap method: how to do it.
abstract: Proper management of abdominal compartment syndrome and open abdomen is important for improving the survival of critically ill patients. However, in cases requiring a prolonged period of open abdomen, it is frequently difficult to perform definitive fascial closure due to lateralization of the abdominal musculature. We herein present a novel combined technique for managing open abdomen. A 74-year-old male with diffuse peritonitis was transferred to our department, after which a long period of open abdomen made it difficult to achieve fascial closure. Polypropylene mesh was sutured to the fascial edges to reduce the gap, which was then serially tightened under negative pressure wound therapy. However, since it was not possible to accomplish definitive fascial closure, abdominal closure was performed using the bilateral anterior rectus abdominis sheath turnover flap method after removing the mesh, without any complications. This combined technique may be an effective alternative in patients requiring open abdomen with subsequent difficulty in achieving definitive fascial closure.
authors.affiliation: Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. amasatoku@nms.ac.jp.
authors.forename: Masatoku
authors.initials: M
authors.lastname: Arai
authors.affiliation: Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kushimoto
authors.affiliation: Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
authors.forename: Shiei
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Masuno
authors.affiliation: Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Hagiwara
authors.affiliation: Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
authors.forename: Hiromoto
authors.initials: H
authors.lastname: Ishii
authors.affiliation: Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yokota
mesh_terms: D000005:Abdomen / Q000601:surgery*; D058107:Abdominal Wound Closure Techniques; D000368:Aged; D006801:Humans; D059325:Intra-Abdominal Hypertension / Q000601:surgery*; D008297:Male; D054843:Negative-Pressure Wound Therapy; D010538:Peritonitis / Q000601:surgery*; D011126:Polypropylenes; D017568:Rectus Abdominis / Q000637:transplantation*; D013524:Surgical Flaps; D013526:Surgical Mesh; D013536:Suture Techniques; D016896:Treatment Outcome
chemical_list: D011126:Polypropylenes
keywords: Bilateral anterior rectus abdominis sheath turnover flap method; Negative pressure wound therapy; Open abdomen