title: Staged repair of severe open abdomens due to high-energy gunshot injuries with early vacuum pack and delayed tissue expansion and dual-sided meshes.
abstract: BACKGROUND
  Open abdomen is a salvage procedure that prevents catastrophes after severe intraabdominal traumas. However, following this life saving attempt, it is mostly not feasible to close the abdomen immediately after the recovery of intraabdominal injuries. Consequently, a staged reconstruction is required, and the first stage is usually a temporary closing approach. At the end of this stage, resulting giant "ventral hernia" is a burden for both the patient and the surgeon. Therefore a permanent repair is subsequently needed. Although there are many treatment modalities described for this goal, etiologies like high-energy gunshots may cause an exactly nuisance scene which can limit treatment options and reduce final success. Herein, it was the objective of this study to present our staged protocol to restore the abdominal wall defect and strategy for optimizing the results in such conundrum cases.
  
  
  METHODS
  Treatment was performed on nine male patients suffering from severe open abdomen due to high-energy gunshot injury. In all patients, temporary closure was provided by negative pressure wound treatment applied directly to the viscera and followed by skin grafting. Late permanent closure was performed with the lamination of expanded abdominal skin and dual-sided meshes.
  
  
  RESULTS
  The follow-up period ranged between 24 months to 4.5 years (mean, 3 years). During this period, no recurrence of ventral hernia, enteric fistula formation, abdominal infection and seroma formation was observed in any patient.
  
  
  CONCLUSIONS
  In this study, NPWT, tissue expansion and dual-sided mesh were used together as a staged procedure for optimizing the results in the clinical scenario of an open abdomen due to high-energy gunshot wound. Results were highly satisfactory for patients and acceptable aesthetically.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Eskisehir Military Hospital, Eskisehir, Turkey.
authors.forename: Doğan
authors.initials: D
authors.lastname: Alhan
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: İsmail
authors.initials: İ
authors.lastname: Şahin
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Kasimpasa Military Hospital, Istanbul, Turkey.
authors.forename: Serbülent
authors.initials: S
authors.lastname: Güzey
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Andaç
authors.initials: A
authors.lastname: Aykan
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Zor
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Serdar
authors.initials: S
authors.lastname: Öztürk
authors.affiliation: Aesthetic Surgery Centre, Ankara, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Nışancı
authors.affiliation: Department of General Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: İsmail Hakkı
authors.initials: İH
authors.lastname: Özerhan
mesh_terms: D000007:Abdominal Injuries / Q000601:surgery*; D000328:Adult; D006801:Humans; D008297:Male; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013526:Surgical Mesh; D015626:Tissue Expansion / Q000379:methods*; D014948:Wounds, Gunshot / Q000601:surgery*; D055815:Young Adult