Closure of the Open Abdomen: a Practical Approach

Abstract

This review focusing on the closure of the open abdomen which is one of the most complicated challenges of the modern critical care surgeon. Three phases of open abdomen can be defined. The first is from the primary damage control operation until all necessary intra-abdominal interventions were concluded. The second is from the end of the first period until closure of the wound. If by the end of the second phase the fascia could not be closed, the skin only coverage is mandated. The third phase is between the skin coverage to the definitive abdominal wall reconstruction. During the first two phases, the abdomen should be covered by a temporary closure technique that should minimize the open abdomen-related complications and facilitate delayed primary closure of the abdomen. Modern temporary closure uses negative pressure therapy in combination with medial traction on the fascial edge. This approach gives the best chance for early delayed primary closure and minimal complication rate.