Failure of the Topical Negative Pressure Abdominal Dressing System in the "Fat" Open Abdomen: Report of a Case and Review of the Literature

P. Steenvoorde, MD, MSc; A.L. Rozeboom, MD; P. Melief, MD; C.V. Elzo Kraemer, MD, PhD; B.A. Bonsing, MD, PhD

Disclosures

Wounds. 2006;18(2):44-50. 

In This Article

Abstract and Introduction

An obese patient presented with a Candida albicans ventriculitis and peritonitis after a ventriculo-peritoneal drain became infected. The open abdomen (laparostomy) was treated with a topical negative pressure (TNP) abdominal dressing system. The patient was first treated with an ileocecal resection, which was later complicated by an abdominal compartment syndrome for which a laparostomy was needed. With the TNP abdominal dressing system alone, the abdominal fascia showed extreme retraction. In the literature, several authors propose the combination of sutures with the TNP system in order to approximate wound edges. The herein described combination of the TNP abdominal dressing system with a progressive Bogotá bag closure is based on the same principles. Despite aggressive surgical and medical therapy, the patient eventually died of a systemic Pseudomonas infection. The TNP abdominal dressing system alone may not be powerful enough to prevent retraction of the fascia. Combination with progressive Bogotá bag closure prevents this but still preserves the essential beneficial effects of the TNP abdominal dressing system.

Swan and Banwell advocate the use of formal topical negative pressure (TNP) abdominal dressing systems for the treatment of open abdomens in cases of exposed bowel, omentum, or intra-abdominal sepsis.[1,2] The formal TNP abdominal dressing system (V.A.C.® Therapy™ System, KCI, San Antonio, Tex) consists of a fenestrated nonadherent piece of plastic with encapsulated foam, which is placed between the abdominal organs and the peritoneum of the abdominal wall. On top of this, an additional layer of polyurethane foam is placed. This is further covered by an overlying adhesive drape to seal (Figure 1-3). This system has many advantages to earlier versions of TNP in combination with the Bogotá bag.[3] The Bogotá bag consists of an open, sterilized 3-L genitourinary irrigation bag that is sewn (with a 1-0 or 2-0 running monofilament nylon suture) to the patient's fascia.[4] However, there are shortcomings to its use, especially with overweight patients in whom wound healing is impaired.[5] The authors present a case of an obese patient in whom the TNP treatment failed and propose an alternative dressing technique in which the TNP abdominal dressing system is combined with progressive Bogotá bag closure.[6]

The fenestrated nonadherent plastic with the encapsulated foam dressing is placed over the abdominal viscera and beneath the peritoneum of the abdominal wall.

An additional layer of polyurethane foam is placed over the encapsulated foam dressing.

The total TNP abdominal dressing system is applied along with subatmospheric pressure.

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