The Abdominal Reapproximation Anchor Device.
BACKGROUND
Achieving primary fascial closure after damage control laparostomy can be challenging. A number of devices are in use, with none having yet emerged as best practice. In July 2013, at Westmead Hospital, we started using the abdominal reapproximation anchor (ABRA; Canica Design, Almonte, Ontario, Canada) device. We report on our experience.


METHODS
A retrospective review of medical records for patients who had open abdomens managed with the ABRA device between July to December 2013 was done. Data extracted included age, sex, body mass index (BMI), reason for the open abdomen, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, number of laparostomies prior to ABRA placement, duration of placement, device complications, length of hospital and intensive care unit (ICU) stay, and outcomes.


RESULTS
Four cases of open abdomens managed using the ABRA device were identified, with 3 a consequence of intra-abdominal sepsis and 1 a consequence of penetrating trauma. Mean BMI was 33.5 kg/m2, APACHE II score was 14.5, duration with open abdomen prior to ABRA placement was 11.75 days, duration with ABRA in situ was 9 days, duration of hospital stay was 64.25 days, and ICU stay was 37.75 days. Three patients (75%) achieved fascial closure, and 1 achieved skin closure. No incidences of enterocutaneous fistulae occurred.


CONCLUSIONS
The ABRA is a unique emerging alternative to aid in achieving fascial closure in patients managed with open abdomens. Our case series demonstrates that it can be used effectively in selected patients. Studies are needed to compare its efficacy with more traditional methods.
1 Westmead Hospital, NSW, Australia.|2 University of Sydney, NSW, Australia.
Alfin
A
Okullo
1 Westmead Hospital, NSW, Australia.
Mehan
M
Siriwardhane
1 Westmead Hospital, NSW, Australia.|2 University of Sydney, NSW, Australia.
Tony C Y
TC
Pang
1 Westmead Hospital, NSW, Australia.
Jane-Louise
JL
Sinclair
1 Westmead Hospital, NSW, Australia.|2 University of Sydney, NSW, Australia.
Vincent W T
VW
Lam
1 Westmead Hospital, NSW, Australia.|2 University of Sydney, NSW, Australia.
Arthur James
AJ
Richardson
1 Westmead Hospital, NSW, Australia.|2 University of Sydney, NSW, Australia.
Henry
H
Pleass
1 Westmead Hospital, NSW, Australia.
Emma
E
Johnston
D034861:Abdominal Wall / Q000601:surgery; D058107:Abdominal Wound Closure Techniques / Q000295:instrumentation*; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014143:Traction / Q000295:instrumentation*
abdominal re-approximation anchor; damage control surgery; hernias; open abdomen