Abdominal wall integrity after open abdomen: long-term results of vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM).
OBJECTIVE
The open abdomen has become a standard technique in the management of critically ill patients undergoing surgery for severe intra-abdominal conditions. Negative pressure and mesh-mediated fascial traction are commonly used and achieve low fistula rates and high fascial closure rates. In this study, long-term results of a standardised treatment approach are presented.


METHODS
Fifty-five patients who underwent OA management for different indications at our institution from 2006 to 2013 were enrolled. All patients were treated under a standardised algorithm that uses a combination of vacuum-assisted wound closure and mesh-mediated fascial traction. Structured follow-up assessments were offered to patients and included a medical history, a clinical examination and abdominal ultrasonography. The data obtained were statistically analysed.


RESULTS
The fascial closure rate was 74 % in an intention-to-treat analysis and 89 % in a per-protocol analysis. The fistula rate was 1.8 %. Thirty-four patients attended follow-up. The median follow-up was 46 months (range 12-88 months). Incisional hernias developed in 35 %. Patients with hernias needed more operative procedures (10.3 vs 3.4, p = 0.03) than patients without hernia formation. A Patient Observer Scar Assessment Scale (POSAS) of 31.1 was calculated. Patients with symptomatic hernias (NAS of 2-10) had a significantly lower mean POSAS score (p = 0.04).


CONCLUSIONS
Vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) seem to result in low complication rates and high fascial closure rates. Abdominal wall reconstruction, which is a challenging and complex procedure and causes considerable patient discomfort, can thus be avoided in the majority of cases. Available results are based on studies involving only a small number of cases. Multi-centre studies and registry-based data are therefore needed to validate these findings.
Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Rübenacher Strasse 170, 56072, Koblenz, Germany. arnulfwillms@gmx.de.
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Willms
Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Rübenacher Strasse 170, 56072, Koblenz, Germany.
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Schaaf
Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Rübenacher Strasse 170, 56072, Koblenz, Germany.
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Schwab
Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Rübenacher Strasse 170, 56072, Koblenz, Germany.
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Richardsen
Department of Trauma Surgery and Orthopaedics, Plastic and Reconstructive Surgery, and Hand Surgery, German Armed Forces Central Hospital of Koblenz, Koblenz, Germany.
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Bieler
Directorate-General for Strategy and Operations, Federal Ministry of Defence, Berlin, Germany.
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Wagner
Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Rübenacher Strasse 170, 56072, Koblenz, Germany.
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Güsgen
D034861:Abdominal Wall / Q000503:physiopathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D016638:Critical Illness; D005205:Fascia; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D011183:Postoperative Complications; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D013526:Surgical Mesh; D014143:Traction; D014945:Wound Healing; D055815:Young Adult
Incisional hernia; Negative pressure therapy; Open abdomen; Outcome; Peritonitis; Primary delayed fascial closure