Negative Pressure Wound Therapy of Open Abdomen and Definitive Closure Techniques After Decompressive Laparotomy

A Single-Center Observational Prospective Study

Mircea Muresan, MD, PhD; Simona Muresan, MD, PhD; Klara Brinzaniuc, MD, PhD; Daniela Sala, MD, PhD; Radu Neagoe, MD, PhD

Disclosures

Wounds. 2018;30(10):310-316. 

In This Article

Results

Prospective Study

The average age in the prospective study group was 66.63 years (range, 49–78 years; SD = 10.11). Of the 19 patients, there were 13 men (68.42%) and 6 women (31.58%). The IAP decreased significantly (P < .001) compared with the initial value after DL (Figure 3).

Figure 3.

Intra-abdominal pressure (IAP) decrease after performing decompressive laparotomy in comparison with the initial value.

The overall mortality rate was 21.05%. The causes of death included septic shock in 2 cases (acute infected pancreatitis and generalized peritonitis after perforated diverticulitis), 1 case of respiratory failure following infected pulmonary contusion after trauma, and 1 case of respiratory failure following bronchopneumonia in a patient with infected pancreatitis and chronic obstructive pulmonary disease. Mortality could be correlated with the type of disease that triggered ACS, being higher (without statistical significance) in infected acute pancreatitis and abdominal trauma (Table 1).

The complications during TAC consisted of 2 wound suppurations in patients who had undergone surgeries for generalized peritonitis after colorectal anastomosis fistula and 1 intestinal obstruction due to adhesions in a patient with a frozen abdomen. With respect to the wound suppurations, they evolved favorably by using NPWT associated with the general treatment, and with respect to the occlusion, resurgery was performed and the adhesions dissolved. The final closure of the abdomen was performed after a mean time of 11.7 days (range, 9–14 days). The closure type was primary suture of the musculoaponeurotic edges in 4 cases and the use of dual mesh in the other 11 cases. The average duration of the patient's hospitalization was 24.7 days.

After the final parietal closure, 1 patient needed split-thickness skin grafting for a presacral eschar. At 1-month postop follow-up, none of the patients showed any clinical or ultrasound defects of the abdominal wall.

Retrospective Study Results

Primary suture was possible in the 2 cases of abdominal trauma. In 5 cases (2 cases of enteral fistula and 3 of acute pancreatitis), definitive closure was performed using substitutive polypropylene dual mesh over the great omentum and attached to the muscular wound margins. Due to the lateral retraction of the wound edges and continuous wound secretions, it was impossible to achieve definitive abdominal closure in 6 cases (3 cases of enteral fistula and 3 of acute pancreatitis); thus, only skin flaps were used, leading to those patients developing a planned incisional hernia.

Local wound complications were encountered in 16 of 21 patients (76.19%), with a mortality rate of 47.61%. The statistical analysis results of the 2 studies are shown in Table 2. The average days of hospitalization, wound suppuration, and planned incisional hernia rates were statistically significantly decreased.

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