Biological Mesh Combined With Topical Negative Pressure Therapy in Complex Abdominal Wounds

A Short Series and a Review of the Literature

Elena Schembari, MD; Antonio Santangelo, MD; Antonio Pesce, MD; Maurizio Mannino, MD; Sofia Maria, MD; Domenico Russello, PhD; Saverio Latteri, MD; Gaetano La Greca, PhD

Disclosures

Wounds. 2020;32(4):93-100. 

In This Article

Abstract and Introduction

Abstract

Introduction: Complex abdominal wounds (CAWs) are an increasing clinical problem in abdominal surgery and pose a challenge for the surgeon.

Objective: This review analyzes the results of treating CAWs with a porcine biological mesh and topical negative pressure (TNP) to address the feasibility, effectiveness, level of risk, and overall results.

Materials and Methods: A series of 4 consecutive cases treated with the biologic mesh and TNP at the General Surgery Unit of the Cannizzaro Hospital (Catania, Italy) is reported and analyzed. In addition, a review of the literature published in all languages from 2000 to 2015 in the MEDLINE/PubMed database was performed to identify cases of CAWs treated with the association of biologic mesh and TNP.

Results: Taking into account the authors' experience and review of literature, a total of 12 patients (4 treated in the authors' department) were treated with the aforementioned combination. The main indications for using this association were a large abdominal wall defect, laparotomy, or wound dehiscence and wound infection. In almost all cases, this combination demonstrated a successful outcome with a clear improvement in wound healing and no adverse effects.

Conclusions: From these cases and the review of the literature, the authors believe TNP can be applied on a biological mesh with effectiveness in improving the treatment of the CAWs without relevant risk to the patient or biological mesh.

Introduction

General surgeons have to deal with increasing clinical problems for both primary and secondary abdominal wall defects, especially if they are combined with local infection. These cases are generally defined as complex abdominal wounds (CAWs). Despite the advances in new technological support and improvement of different available devices for the treatment of CAWs, a statistical analysis of experimental and/or clinical combinations of individually tested devices is impossible due to the variability of these cases.[1] Therefore, experience, empirical clinical experimentation, and detailed reports of used treatments for these complex cases remain the only opportunity for a contribution to the progress of medical practice.

Chronic abdominal wounds represent a challenge for surgeons, especially because they have to deal not only with patient expectations regarding quick and complete healing but also their comorbidities. Furthermore, a CAW is difficult to treat because multiple factors contribute to the alteration of the normal healing process and are often the cause of a wound's spontaneous dehiscence.[2] Sometimes, a major abdominal wall defect also can be the consequence of a still-existing incisional hernia.[3] Aiming to manage these often life-threatening situations, surgeons have adopted and implemented different methods, including older techniques such as the Wittmann Patch, Bogota bag, and packing.[4]

Despite all of these possibilities, the incidence of complications remains high[4] (eg, incisional hernia, evisceration, cutaneous fistulas, seromas, and local infections), all leading to abnormal repair processes that result in prolonged hospital stay and increased costs. Currently, there is the possibility of using and combining some of the different techniques, solutions, and sophisticated devices such as those based on topical negative pressure (TNP; ACTIV.A.C. Therapy System [KCI, an Acelity Company, San Antonio, TX] with biological mesh), but unfortunately the effectiveness and risks of this combination are not widely described in the literature, as evidenced by the present review. Separately, TNP[5] and the biological mesh[6] have been effective in treating CAWs, but there are no clinical data, studies, or retrospective reviews concerning this combination. Moreover, the aforementioned products are expensive. Any data concerning the effectiveness of their combined use that demonstrates their possible implementation and positive results and indicates a significant reduction in hospital stay (thus overall costs) would be very important. Herein, the authors analyzed a short series of patients treated with this combination showing positive results and included a review of the literature to clarify its effectiveness.

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